100,000 Practitioners Using Electronic Prescribing Systems   Ryan Haight Online Pharmacy Consumer Protection Act Interim Rules take Effect   Florida Board of Pharmacy Considering Expansion of Technician Authority   Medical Home Pilot Project Approved by Florida Senate   Prescription Drug Validation Program Passes Senate - House Passage Pending   Consolidation of Statewide Prescription Drug Purchasing   State of Florida Budget Discussions Continue   Exemption for DME Accreditation Bills Filed in Congress   AHCA Announces Medicaid Health Information Exchange Demonstration   Bill on USF Pharmacy School Passes Florida House   Diabetes 10 Cities Project Results Reporting Favorable

ALEXANDRIA, Va. and ST. PAUL, Minn. – April 22, 2009 – Surescripts®, which operates the country’s largest national electronic prescribing network has announced that more than 100,000 prescribers are now routing prescriptions electronically in the U.S. What’s more, the use of three critical components of e-prescribing – electronic prescription benefit, history and routing – jumped 61 percent in the first quarter of 2009, resulting in more than 134 million e-prescribing messages being exchanged among prescribers, payers and pharmacies. “In the past two years, the U.S. has gone from 19,000 to 103,000 prescribers routing prescriptions electronically – punctuated by 39 percent sequential growth in prescriber adoption in the first quarter of this year,” said Harry Totonis, president and CEO of Surescripts. “The past two years have also witnessed a sevenfold increase in the use of e-prescribing. And while this growth shows clear evidence that the steps taken by policymakers, prescribers, payers, pharmacies and others are having a positive impact, swift and specific action is required for the U.S. to achieve mainstream adoption and use of e-prescribing.”

 

Editor's Note:  Members need to be aware that the Drug Enforcement Administration only recognizes written prescriptions for controlled substances with some exceptions for faxed and oral prescriptions.  Draft rules are currently under consideration with the comment period having expired in September of 2008.  Members also should be familiar with dispensing systems that are interfaced with electronic prescribing software.  We have reported that nearly all chain pharmacies are enabled to receive electronic prescriptions however a disproportionate number of independent pharmacies are not actively participating.  While the number of prescriptions is small in comparison to the total number transmitted electronically the electronic prescription count is increasing.

 

 

The Ryan Haight Online Pharmacy Consumer Protection Act, which was enacted by Congress on October 15, 2008, amended the Controlled Substances Act and Controlled Substances Import and Export Act by adding several new provisions to prevent the illegal distribution and dispensing of controlled substances by means of the Internet. It requires online pharmacies to register and to report to the Attorney General (AG) regarding controlled substances dispensed via the internet. The legislation requires a valid prescription for controlled substances delivered, distributed, or dispensed by online pharmacies and requires online pharmacies to disclose contact information, and other information, on their website. Online pharmacies are required to notify the AG prior to dispensing, delivering, or distributing medications. The law also defines the practice of telemedicine and includes special registration requirements for practitioners who engage in the practice of telemedicine and establishes criminal penalties for violating the Act.  Information about the interim rule for on line pharmacies can be found through this link.

 

 

The Florida Board of Pharmacy in a Committee meeting in February examined a number of draft rules related to pharmacist technicians.  A draft version of a rule that was recommended for review by the full board at their meeting on April 15, 2009 included proposed language that would allow pharmacy technicians to initiate communications with a prescriber's office that was illegible "or missing".  Association leadership expressed concern that the delegation by rule tasks related to missing information on a prescription is best kept with the pharmacist or pharmacy intern under the supervision of a pharmacist.  The Association drafted a letter of concern to the Board asking that this section of the rule be removed.  A copy of the letter can be found at this link.  The Board tabled a decision on this rule and instead elected to place it on the agenda for their June meeting in Fort Lauderdale.

 

 

The Florida Senate on Friday adopted CS for CS for CS for SB 1986 authorizing the creation of a medical home network pilot study.  The pilot project under the Agency for Health Care Administration is designed o utilize primary care management enhanced by medical home networks to provide coordinated and cost-effective care that is reimbursed on a fee-for-service basis and to compare the performance of the medical home network with other existing Medicaid managed care models.  Each medical home network shall provide recipients primary care, coordinated services to control chronic illness, pharmacy services, specialty physician services, hospital outpatient and inpatient services.  The implementation plan has to be submitted to the Speaker of the House and President of the Senate by February 1, 2010.  Included in the legislation are also a number of sweeping fraud and abuse provisions to address provider misconduct.  There is language in the bill that requires the fingerprinting of pharmacy permit applicants (including those individuals who manage, oversee or controls the operation of the pharmacy applicant.  Applicants must attest that they have never filled a prescription that was know to be not based upon a valid practitioner-patient relationship.  The Association has found similar language on a number of other bills.

 

 

Prescription drug validation program legislation (CS for CS for CS for SB462) being monitored by the Florida Pharmacy Association has been read for the 3rd time and has passed the Florida Senate.  These bills if signed into law would require pharmacies and other dispensing providers to report controlled substance dispensing data to the Department of Health.  Features of SB 462 include but are not limited to the following:

Failure to report the dispensing of controlled substances is a first degree misdemeanor.  All costs to the state must be funded through federal grants or any private funding received by the state.  The Office of Drug Control may create a not for profit direct-support organization to raise funds, receive grants etc in furthance of the prescription drug monitoring program.  The bill also requires the presentation of a photo ID prior to the dispensing of a controlled substance.  This portion of the bill is consistent with current Florida Board of Pharmacy rules.  The bill also creates a task force appointed by the Governor to monitor the implementation and safeguarding of the electronic system of the prescription drug monitoring program.  Privately owned pain management clinics and other related entities would be required to register with the Department of Health.  The House version HB897 has completed its committee work and is preparing for passage on the House side.  There are companion bills designed to exempt the data from public records requests. 

Editor's Note: The Association has learned that there are a number of unfriendly amendments that are being offered to make the law difficult for pharmacy providers.  One such amendment will require the reporting of the data within 7 days rather than within 15 days.

 

Senate bill 2614 creates the Pharmacy and Therapeutic Advisory Council in the Executive Office of the Governor to promote quality, consistency, and efficiency in the state purchasing and administration of pharmaceuticals.  The bill also includes the development of a drug-utilization review process across agencies and the review of agency proposals to maximize the cost-effectiveness of the purchasing of pharmaceuticals. The bill requires all but a few state agencies to purchase drugs through the statewide purchasing contract administered by the Department of Health unless the Council approves a more cost-effective agency plan or the drugs required are not available through the contract. The similar House version is HB1471.

 

 

With one week left of the regular session The Florida House and Senate budget discussions are still far apart.  From what we can determine the Florida Senate is not showing any reductions for pharmacy in the Medicaid program.  The overall state budget being reviewed is about $65 billion.  The gap between the House and Senate is a massive $547 million with means that either side may have to give on their issues.  Even though Medicaid pharmacy reimbursement is not on the table from what we can determine it could be looked at to try to close the gap.  FPA membership is encouraged to reach out to members of the Florida House of Representatives and ask that Medicaid reimbursment for pharmacy providers be held harmless to any reimbursement reductions.  With the gap between chambers so large it is very likely that the regular session will be extended beyond this weekend.

 

 

Two bills have been filed in Congress to address the pharmacy durable medical equipment accreditation requirements.  Community pharmacists are the only licensed medical professionals that must meet new Center for Medicare for Medicaid Services accreditation requirements as Medicare suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).  Accreditation costs for pharmacies range from $5,000 to $7,000.  The accreditation process for providers delivering DMEPOS services was supposed to be in place by January 1, 2009.  An approved accreditation needs to be in place by September 30, 2009 or providers may have difficulty with billing.  Members are encouraged to contact members of Congress in Washington, D.C. and ask that they support and co-sponsor S 511 and H.R. 616.

 

AHCA Announces Medicaid Health Information Exchange Demonstration

 

The Florida Agency for Health Care Administration (AHCA) announced that it has partnered with Availity L.L.C. to implement a new demonstration project that will provide physicians and patients with access to Medicaid claims-based electronic health records. A Request for Information was issued in November to explore the feasibility of partnering with a vendor to provide this type of health information exchange (HIE) at no cost to AHCA, health care providers, and Medicaid recipients. This initiative serves to promote the effective use and exchange of health care information in a secure environment and reflects the intent of the health information technology provisions of the American Recovery and Reinvestment Act of 2009.  According to Agency for Health Care Administration Secretary Holly Benson, “Health care professionals armed with more complete information at the time of service can improve coordination, avoid duplication of tests, and encourage preventive care.” Availity will include Medicaid patient eligibility and benefit information as well as medical and prescription claims history from all of their participating payers including Florida Medicaid. In year two, Availity will integrate data from multiple sources and develop patient-centric views that will further facilitate identification of duplications or gaps in care. Providers must access the data for treatment purposes only and must have explicit authorization from the patient to access the Medicaid data except in a medical emergency where the patient or family is unable or unavailable to consent.

 

 

House bill 75 has been found unaminously favorable by a vote of 117 to 0.  The bill is now in the Florida Senate messages waiting on action in that chamber.  This bill if signed into law authorizes the creation of a doctor of pharmacy degree program at the University of South Florida which would bring the total number of pharmacy academic universities in Florida to six.  During testimony questions were asked of the new school would require additional appropriations.  From what we can determine there are no funds that have been requested for this school.

 

 

An employer based pharmacist diabetes care management program was implemented in various cities across the country.  The Florida Pharmacy Association participated in this project which was sponsored by the American Pharmacists Association Foundation with support from GlaxoSmithKline. Through the Diabetes Ten City Challenge, sponsored by the APhA Foundation with support from GlaxoSmithKline, employers provided employees, dependents and retirees with diabetes a voluntary health benefit, waived co-pays for diabetes medications and supplies and helped people manage their diabetes on a day to day basis with the help of a specially-trained pharmacist "coach".  Results have been released on the 10 Cities Project web site and are favorable.  Information about this project can be found at this link.

 

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