SENATE BILL REPORT

SB 5213

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by Senate Committee On:

Health Care, February 19, 2013

Ways & Means, February 28, 2013

Title: An act relating to prescription review for medicaid managed care enrollees.

Brief Description: Concerning prescription review for medicaid managed care enrollees.

Sponsors: Senators Becker, Tom, Bailey, Honeyford and Frockt.

Brief History:

Committee Activity: Health Care: 2/05/13, 2/19/13 [DPS-WM].

Ways & Means: 2/25/13, 2/28/13 [DP2S].

SENATE COMMITTEE ON HEALTH CARE

Majority Report: That Substitute Senate Bill No. 5213 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.

Signed by Senators Becker, Chair; Dammeier, Vice Chair; Keiser, Ranking Member; Bailey, Cleveland, Ericksen, Frockt, Parlette and Schlicher.

Staff: Mich'l Needham (786-7442)

SENATE COMMITTEE ON WAYS & MEANS

Majority Report: That Second Substitute Senate Bill No. 5213 be substituted therefor, and the second substitute bill do pass.

Signed by Senators Hill, Chair; Baumgartner, Vice Chair; Honeyford, Capital Budget Chair; Hargrove, Ranking Member; Nelson, Assistant Ranking Member; Bailey, Becker, Braun, Conway, Dammeier, Fraser, Hasegawa, Hatfield, Hewitt, Keiser, Kohl-Welles, Murray, Padden, Parlette, Ranker, Rivers, Schoesler and Tom.

Staff: Michael Bezanson (786-7449)

Background: For fiscal year 2013, 63 percent, or approximately 780,000 of the 1.2 million Medicaid enrollees are forecasted to be enrolled in managed care. The Health Care Authority (HCA) estimates that 40,000 or 5 percent of enrollees in managed care have five or more prescriptions.

Under state law, HCA must adopt a uniform procedure to enter into contractual agreements with managed care plans. These procedures must follow certain provisions including provider reimbursement methods that incentivize chronic care management within health homes.

Summary of Bill (Recommended Second Substitute): HCA contracts for Medicaid-managed care plans must include a requirement that provides for reimbursement methods that incentivizes pharmacists and primary care providers licensed in Washington to provide comprehensive medication management services.

A comprehensive medication management process means utilizing a licensed pharmacist or primary care provider to assess patients taking five or more medications for two or more chronic medical conditions, with the following services:

EFFECT OF CHANGES MADE BY WAYS & MEANS COMMITTEE (Recommended Second Substitute): Changes the term comprehensive medication management process to comprehensive medication management services and corrects references. Revises the reference of licensed pharmacist to pharmacist or primary care provider licensed in Washington State. Moves the references of the contract date for Medicaid-managed care contracts and inserts the language for the comprehensive medication management into the medical home section with reference to providing reimbursement methods that incentivize pharmacist and primary care providers to provide comprehensive medication management services.

EFFECT OF CHANGES MADE BY HEALTH CARE COMMITTEE (Recommended First Substitute): A definition for comprehensive medication management process with a licensed pharmacist or primary care provider is created; comprehensive medication management services are inserted into language regarding the provider incentives to manage chronic care within health homes; and the managed care contracts must include language by January 1, 2014 to include a comprehensive medication management process instead of the automatic review process, with a licensed pharmacist or the primary care provider to verify that the prescriptions are appropriate.

Appropriation: None.

Fiscal Note: Available.

Committee/Commission/Task Force Created: No.

Effective Date: Ninety days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony on Original Bill (Health Care): PRO: Many patients with chronic health conditions end up on multiple medications that can have interactions and adverse reactions. It is important to have a review once per year of all the medications a patient is taking. Pharmacists are trained in managing medications – that is the true value they can add to health care. We need to rethink how we use pharmacists as part of the care team that more effectively manages the patient's medications. Medicare Part D requires a review of medications. It is important to provide more direction in the bill on prescription review. Perhaps a clarifying amendment could define comprehensive medication management or medication therapy management as is used in Medicare Part D.

OTHER: We are a plan that participates in the Medicaid-managed care contracts and they already require the development of health homes and chronic care management. It might be more helpful to place the language in the health home section adding to the list of activities that providers are incented to manage. We agree this is the right idea but not the right context. Medication management is a critical piece of care management. It may be more appropriate to reference the activity within the health home requirements since that section includes the pharmacist as a part of the care team. The language could also be added to all HCA contracts with health home language. Medicare and Medicaid already require health records with the list of medications in the electronic health record and it is not clear that additional scrutiny is necessary. The threshold of five medications is too low and may sweep nearly everyone into a review, and the review may just create more paperwork.

Persons Testifying (Health Care): PRO: Senator Becker, prime sponsor; Jeff Rochon, WA State Pharmacy Assn.; Lisa Thatcher, GlaxoSmithKline.

OTHER: Dave Knutson, United Healthcare; Mary Clogston, WA Academy of Family Physicians; Leslie Emerick, Assn. of Advanced Practice Psychiatric Nurses.

Staff Summary of Public Testimony on Substitute (Ways & Means): PRO: Patients can be prescribed and take numerous medications. The over-utilization of drugs can cause serious health concerns. The bill addresses a huge need for and lack of communication across a wide array of medical providers. This is the first time that there will be standardization of a comprehensive review. There are technical changes that can be made to alleviate all stakeholders' concerns. Outcomes and benefits from the reduction of over-utilization will far outweigh any costs from this bill.

CON: We agree with the goals of the bill but the bill is over-prescriptive in how to perform the medication review and more flexibility is needed. The bill should work but it should not be duplicative of other efforts that are underway or are currently required. Not all providers are versed in prescription drugs in other fields such as psychiatric medicine and vice versa. This can be problematic.

Persons Testifying (Ways & Means): PRO: Senator Becker, prime sponsor; Jeff Rochon, WA State Pharmacy Assn.; Lisa Thatcher, GlaxoSmithKline.

CON: Mary Clogston, WA Academy of Family Physicians; Leslie Emerick, Assn. of Advanced Practice Psychiatric Nurses.