SENATE BILL REPORT
SB 5441
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 of February 10, 2015
Title: An act relating to patient medication coordination.
Brief Description: Addressing patient medication coordination.
Sponsors: Senators Rivers, Frockt, Parlette, Bailey, Conway, Keiser and Benton.
Brief History:
Committee Activity: Health Care: 2/09/15.
SENATE COMMITTEE ON HEALTH CARE |
Staff: Mich'l Needham (786-7442)
Background: Medication coordination, or medication synchronization, is an emerging pharmacy practice focused on patients that have multiple medications for chronic conditions by encouraging patients to pick up all their recurring monthly prescriptions on the same day, usually once per month. The concept is often paired with an appointment-based model which involves the pharmacy coordinating medication refills and scheduling a pick-up date for the patient. An evaluation of the model in a midwest pharmacy indicated some patients demonstrated greater adherence with prescribed medications.
Effective January 1, 2014, Medicare began allowing a pro-rated drug copayment for dispensing less than a 30-day supply to assist patients in moving to a synchronized schedule for medication refills.
Summary of Bill: Health insurance plans, including the self-insured Uniform Medical Plan, that provide coverage for prescription drugs must not deny coverage and must pro-rate the cost sharing for a prescription drug that is dispensed by a network pharmacy for less than the standard refill amount if the prescribing provider or pharmacist determines that filling or refilling the prescription is in the best interest of the enrollee; and the enrollee requests or agrees to less than the standard refill amount for the purposes of synchronizing medications.
Health plans must allow a pharmacy to override a denial code related to an early refill if the prescription is part of a medication synchronization program, and health plans must pay a full pharmacy dispensing fee for each prescription dispensed and may not prorate a dispensing fee.
Medication synchronization means the coordination of medication refills for a patient taking two or more medications for a chronic condition to allow the medications to be refilled on the same schedule.
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: PRO: While caring for my terminally ill mother, we spent a lot of time making trips to the pharmacy for refills and I would have appreciated synchronizing the refills. The check in with a pharmacist provides a valuable resource for a patient taking multiple medications. Patients may have trouble with transportation and this will assist them. The medication synchronization targets patients with long-term medications and helps with compliance. There are similar bills moving in other states. I know patients with chronic conditions that have attempted to stockpile their medications to try and synchronize their refills but that has placed them in jeopardy since they haven't been taking their medications appropriately. We have a program targeting high-risk vulnerable patients with multiple mediations and we have found their in-home education helps review the medications, simplify the medications and refills, and improve compliance. Medication adherence is a big problem that can be harmful for patients and drive up health care system costs. This change helps the patient, improves adherence, and removes the financial burden on the patient with the coordinated co-pays.
OTHER: We support the concept of synchronizing medication and Regence has had a program for a long time. We have concerns with this approach since synchronization is not appropriate for every medication, some medications are not allowed to have early refills. The requirement for the cost sharing created burdensome administrative requirements. The Oregon model may be a more thoughtful approach. Premera has a policy in place as well that supports synchronization. We also have the pharmacy benefit manager review patients with multiple medications for interactions. The Oregon bill provides a good starting point. We appreciate the intent and the concerns around medication synchronization and Group Health has systems in place now that allow early refills and mail order refills. We would support language like Oregon's.
Persons Testifying: PRO: Senator Rivers, prime sponsor; Jennifer Vandevelde, National Patient Advocate Foundation; Helen Nilon, Behavioral Health & Wellness, Executive Director; Ryan Oftebro, Kelley-Ross Pharmacy; Jeff Rochon, WA State Pharmacy Assn.
OTHER: Len Sorrin, Premera; Chris Bandoli, Regence; Sydney Smith Zvara, Assn. of WA Health Plans; Mel Sorensen, America's Health Insurance, Express Scripts; Chris Marr, Group Health.