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 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 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 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: 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 340B still gets attention

5. States & 340B = Growing!

6. States get creative with 340B States may: 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 2005 Law Examples: CO (vetoed), ME, NY, UT –Bills: CA, HI, MA, MN, NM, RI 2004 Law Examples: NM, VT 2004 Law Examples: NM, VT –Bills: CO, CT, KY, MD, MN, VA 2003, etc… 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) (VETOED by gov. 6/1/05) 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. (In committee) 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). (Passed both chambers, but did not pass conference 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) NM SB 11: Would expand pharmacy services in primary care clinics. (Did not pass by end of session) (In committee) 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.“SJM 35 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. SB 338, now Chapter 315 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.HB 88

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 Laws: AR, MD and TX- 2001 Arkansas HB 2498 of 2001 authorizes expanded use, creation or designation of FQHCs to get "substantially discounted prescription drug prices."HB 2498 Maryland HB 6 of 2001 requires the state to study the feasibility of purchasing prescription drugs through FQHCs.HB 6 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."HB 915   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.SB 347

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.aphanet.org/ – –www.ncsl.org/programs/health/drug340B.htm