Prior Auth & Drug Pricing Reforms Move Forward

The Minnesota Legislature is required to adjourn session no later than May 18, 2020. The pace at the Capitol has quickened, but the process remains very unusual (given social distancing guidelines).

Our legislative rep Dave Renner, CAE, provides an update on legislation regarding prior authorization reform, drug pricing transparency and scope of practice.

Prior Authorization Reform Advances

Long a priority for the MAFP, legislation to reform the laws governing prior authorization cleared several committees in recent days. The Senate bill, authored by Senator Julie Rosen (R – Vernon Center), unanimously passed the Health and Human Service Policy and Finance Committee and was referred to the Commerce Committee. The House companion, carried by Representative Kelly Morrison, MD (DFL – Deephaven), an OB/GYN, passed the House Commerce Committee by a unanimous margin and was referred to the House floor where it is expected to be considered as soon as next week.

The bill does not prohibit the use of prior authorization, but contains several provisions intended to reduce administrative burden while enhancing access to care for patients.

PRIOR AUTHORIZATION REFORMS INCLUDE:

Shortening the time that health plans are allowed to make prior authorization determinations. Standard determinations are to be completed within 5 business days (down from 10 in current law), while expedited determinations are to be made within 48 hours (down from 72 hours). Appeals of prior authorization denials are to be made within 15 days, down from the current law’s allowance of 30 days. These changes are effective January 1, 2021.

Requiring that prior authorization denials of procedures and diagnostic testing be made by Minnesota-licensed physicians who practice in the same or similar specialty as the service being reviewed.

Requiring that health plans provide a 60-day transition period for patients who have approved services should they change health plans.

Requiring health plans and utilization review organizations to post on their website the clinical criteria for their prior authorization procedures and provide providers at least a 45-day notice of any changes to the criteria they use prior to the change taking effect.

Precluding health plans from retroactively denying prior authorization approvals once granted.

Precluding health plans from changing coverage terms or clinical criteria during the plan year for patients who have an approved prior authorization.

Drug Pricing Transparency Bill Clears Senate

In an effort to assist consumers and policy makers in understanding prescription drug pricing, legislation to require extensive reporting by drug manufacturers when the price of drugs sharply increase passed the Senate by a 63 to 2 margin.

Authored by Senator Julie Rosen (R – Vernon Center) and Representative Kelly Morrison, MD (DFL – Deephaven), the bill mandates that prescription drug manufacturers report to the Minnesota Department of Health when drug prices increase by certain margins within a given time period: Manufacturers would be compelled to report when a brand name drug increases by 10 percent within 12 months or by 16 percent over a 24-month period, and manufacturers of generic drugs would be required to report when a generic drug increases by 50 percent within 12 months.

The bill further stipulates that reports include information on the cost to manufacture the drug, the wholesale cost of the drug, the factors that led to the price increase, marketing and advertising costs for the drug and more. The Minnesota Department of Health is tasked with publicly reporting the data as well as providing regular reports to the Legislature.

Scaled Back Scope of Practice Bills Move Forward

A package of scope of practice changes cleared the Senate on a unanimous vote on May 7, 2020, while the House companion passed out of its last committee and was referred to the House floor.

The legislation requires that a physician’s assistant (PA) maintain a “practice agreement” with a Minnesota-licensed physician that describes the practice of the PA. The bill further requires an annual review of the practice agreement by a licensed physician “within the same clinic, hospital, health system or other facility to ensure that the medical practice of the PA is consistent with the practice agreement.” Newly licensed PAs must practice within a more prescriptive collaborative agreement within an integrated system for one year prior to being allowed to work under a practice agreement.

Another provision in the omnibus bill grants pharmacists limited prescribing authority for several types of drugs where a diagnosis is not required. Originally authored by two MAFP members, Senator Scott Jensen, MD (R – Chaska) and Representative Alice Mann, MD (DFL – Lakeville), the bill allows pharmacists to prescribe nicotine replacement drugs, oral contraceptives for the purpose of birth control and opioid antagonists for acute opioid overdose. Prior to being eligible to prescribe these drugs, pharmacists would be required to complete a training course developed by the Board of Medical Practice and Board of Pharmacy, with the input of the professional association of physicians, pharmacists and APRNs.

A final scope of practice provision included will allow traditional midwives the authority to order ultrasounds, provide point-of-care testing and order laboratory tests that conform to the standard prenatal protocol of the licensed traditional midwife’s standard of care.

Of note: Two more controversial scope of practice bills are NOT moving forward: legislation to allow physical therapists to remove the 90-day limit on direct care and a proposal by the optometrists to administer interocular injections as well as remove existing limits on prescribing oral antiviral medications and oral carbonic anhydrase inhibitors (none of these were included in the omnibus bills).

_ _ _ _ _ _ _ _

Author: Dave Renner, CAE, legislative rep, @daverenner

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s