New Laws in 2005

Lowers age for pharmacist-provided influenza immunizations to 15. Becomes la w Jan. 1, 2006. We originally sought broader authority to administer any vaccine to adolescents, but we were opposed by the Oregon Medical Association and the state immunization program. The CDC recently called for special efforts to reach adolescents with a variety of vaccines, so this issue may be worth another look in 2007.

Gives the State Board of Pharmacy complete licensing authority for pharmacy technicians, and opens the Board's supervised substance abuse recovery program to technicians. The bill also includes a technical fix to wholesaler licensing language to allow food banks to obtain OTC licenses. Became law on June 28. For the first time since tech licensing first came before the Legislature in the mid-1990s, there was no opposition to the concept. There remain unsettled issues regarding possible entry requirements for technicians, but the statutory framework is in place to allow the Board to adopt rules as the profession and the Board come to agreement on technicianrelated regulatory issues.

Our auspiciously numbered legislation clarifying the ability of pharmacists to engage in therapeutic interchange died in committee. However, during two lengthy hearings it sparked a productive discussion about the role of pharmacists in managing drug therapy. The Oregon Medical Association agreed that therapeutic interchange is beneficial to patients, providers and payers, and a number of payers quietly supported the bill. Unfortunately, the combined opposition of the Oregon Trial Lawyers Association and drug manufacturers killed the bill.

Response to illegal methamphetamine manufacturing and trafficking may be the signature issue of the 2005 Legislature. With the governor, attorney general, law enforcement and legislators of both parties vocally seeking to restrict access to components of meth, including pseudoephedrine, it was clear from the outset that restrictions would be enacted into law. The only questions were what scope of restrictions would be enacted and what new distribution regulations would be imposed. OSPA played a key role in crafting provisions of HB 2485 that will make all forms of pseudoephedrine Schedule III controlled substances by July 1, 2006. At various points in the session, legislators seriously considered a total ban on pseudoephedrine, as well as varying degrees of distribution regulation and requirements for pharmacies to keep paper logs of sales. The final version struck a balance among patient access to pseudoephedrine for those who need it, administrative burdens on pharmacies, and blocking access for those who would use the product to manufacture meth. Senate Memorial 3, adopted on the eve of U.S. Senate Judiciary Committee action on federal meth legislation, urged Congress not to pre-empt state controls on pseudoephedrine. OSPA organized a press conference with the memorial's co-sponsors, which caught the attention of Oregon Sens. Ron Wyden and Gordon Smith; both Smith and Wyden, neither of whom had previously committed on the preemption issue, weighed in with the Judiciary Committee in opposition to pre-emption of state regulation.

Would have allowed the State Board of Pharmacy to establish a federally funded controlled substances reporting program similar to those in existence in many other states. SB 180 died in the Senate Human Services Committee, and a revised version, SB 1093, was introduced late in the session and died in the Senate Rules Committee.

Would have required the State Board of Pharmacy to license foreign pharmacies and wholesalers for purposes of drug importation. Died without a hearing.

Adds a pharmacist position to the Pain Management Commission and requires pharmacists to complete a pain management continuing education program. OSPA agreed not to oppose the bill. Becomes law Jan. 1, 2006.

Revises definition of "independent contractor" for purposes of taxation and workers compensation. Due to the impact on relief pharmacists and in light of past agency resistance to changes in the statute, OSPA sought amendments requiring close oversight by the legislature. The amendments were rejected by the Senate, but the chairman of the House Business, Labor and Consumer Affairs Committee agreed to further study of the issue in the interim.

Would have expanded the state's prescription drug "bulk purchasing" program. Passed the Senate, died in the House Budget Committee. OSPA opposed the measure.

As amended by the Senate Human Services Committee, the bill would have exp anded the rural health tax credit to include pharmacists. It died in the Senate Revenue Committee, as did a similar House measure. House Revenue Committee Chairman Tom Butler plans to include discussion of rural tax credits in the committee's interim work.

Expands the Rural Health Services Program, which provides relief from state student loans, to include (as a result of OSPA amendments) certain pharmacists. Became law on July 1, 2005.

Allows clinical nurse specialists to prescribe and dispense drugs. OSPA negotiated with the Oregon Nurses Association to limit the scope of dispensing. Becomes law Jan. 1, 2006.

Would have created an interim Task Force on Electronic Medical Records to make recommendations to the 2007 Legislature. Pharmacy was overlooked in the original bill; an OSPA amendment added a pharmacy representative to the Task Force. Died in House Budget Committee.

Allows the Medicaid program to pay only for a brand- name drug if the cost of a brand net of available rebates is less than the cost of a generic and the Medicaid program first notifies the pharmacy. The original language, which OSPA opposed, mandated use of branded drugs and lacked a notice requirement. Became law on Aug. 3.

Would have given the Oregon Patient Safety Commission authority to impose fees on healthcare entities under its jurisdiction. There was no known opposition, but the bill became a vehicle for a broad range of unrelated amendments. As a result, it was held by House leaders as an end-ofsession tool and died in committee. The commission now must rely upon voluntary participation to support its operations.

Would have allowed pharmacists to dispense emergency contraception by protocol. Passed Senate 22-6, died in House Judiciary Committee without a hearing. This was the first time either the House or Senate held a floor vote on limited prescriptive authority by protocol.

Clarifies nurse practitioners' scope of practice. As a result of discussions between OSPA and the Oregon Nurses Association, the scope of nurse practitioner dispensing is not expanded. However, the bill corrects a technical error made by the 2003 Legislature by restoring dispensing authority for nurse practitioners at university student health clinics. Becomes law Jan. 1, 2006.

Proposed specific standards to ensure pedigree of prescription drugs through the supply chain. OSPA opposed the bill, and the proponents agreed to participate in a workgroup to discuss possible State Board of Pharmacy rulemaking. OSPA will convene a workgroup this fall.

Authorizes the Department of Human Services to modify the Medicaid program and make rules as necessary to implement the Medicare Part D drug benefit. OSPA will work with legislators on this issue in the interim, including a proposal to provide Part D co-payments for low-income patients in non-skilled community based care (i.e. assisted living, foster care, in-home care).

Allows the State Board of Pharmacy to establish its own budget account, apart from the Department of Human Services. This will simplify the Board's biennial budgeting process and will help the Board to better manage its financial affairs. Became law July 1, 2005.

Allows professional licensing boards, including Board of Pharmacy, to offer multi-year licenses, with proportionate adjustment of fees and CE requirements. Becomes law Jan. 1, 2006.

Would have prohibited the state Medicaid program from imposing prior authorizatio ns on Hepatitis C medications. OSPA testified in opposition to the bill, noting the appropriateness of clinically based prior authorizations on a particularly expensive drug therapy. It passed the House and Senate, but the record created in committee provided justification for Gov. Kulongoski to veto the bill.

Department of Human Services budget bill. For the first time since 1999, pharmacy reimbursement in the Medicaid fee- for-service program was not an issue - in large part because of groundwork laid during the 2003 Legislature. That's the good news. The bad news: Oregon's Medicaid expansion is a much smaller program than it was four years ago, and it seems likely to remain so. The budget directs the Medicaid program to study possible savings from dispensing brand-name drugs in place of generics under limited circumstances. (See SB 782.)