Health policy legislation on the move in Honolulu

With first crossover later this week, we’ve seen some health policy bills move forward and others stall in the capitol. Here’s an update on some of the major legislation themes we’ve been tracking.

Homelessness and Affordable Housing

Neither HB 1925 nor SB 2025 have moved this session. HB 1925 would have created a state lottery task force to consider the feasibility of establishing a state lottery with the proceeds funding homeless issues. The bill was referred to the Judiciary Committee near the end of January, but still has not been scheduled for a hearing. SB 2025, which would have required all health plans to provide coverage for the treatment of homelessness, has been deferred.

HCR 31 was recently offered and has been referred to the House Health and Human Services Committee. The resolution requests an audit of all programs dealing with homelessness that are administrated by DHS.

Opioids

HB 1924 to authorize a pharmacist to prescribe and dispense opioid antagonists, such as naloxone, without a written collaborate agreement passed out of the Health and Human Services Committee and has been referred to the Consumer Protection & Commerce Committee.

HB 2531 would require prescribers of certain controlled substances to first consult Prescription Drug Monitoring Program before issuing the prescription. Currently, 36 states have laws in place to require use of the state PDMP. The bill has passed out of the HHS and CPC committees, and has been referred to the Judiciary Committee.

HB 2611 has passed out of the House. The bill would appropriate money for the DOH to fund substance abuse treatment programs.

Prescription Drugs

While HB 2644 has not moved in the House, its companion bill SB 3104 has been placed on its Third Reading with a recommendation of passage from the Senate Ways and Means Committee. The bill would create requirements for Pharmacy Benefits Managers and maximum allowable costs. The Department of Commerce and Consumer Affairs would regulate the new requirements, not the Department of Health. Contracting pharmacies would be allowed to provide the maximum allowable cost list and related information to any third party.

According to the Commerce, Consumer Protection, and Health Committee report:

“Your Committee finds that a drug’s maximum allowable cost is the top limit that a pharmacy benefit manager will pay a pharmacy for multi-source generic drugs, while a maximum allowable cost list is a list of the maximum allowable reimbursement costs of multi-source generic drugs established by a pharmacy benefit manager.  In general, no two maximum allowable cost lists are alike and will vary according to drug, pharmacy benefit manager, and health plan sponsor.  However, the lack of transparency surrounding maximum allowable cost pricing has enabled pharmacy benefit managers to pay aggressively low reimbursements to pharmacies, while charging significantly higher amounts for the same drug to plan sponsors.  Furthermore, because pharmacy benefit managers control the formularies for prices, like those through a maximum allowable cost list, a pharmacy benefit manager has the ability to create pricing uncertainty for pharmacies.”

The committee found that independent pharmacies have seen drastic reductions in reimbursement from PBMs, and nearly all reimbursement appeals are denied.

Other bills

The Medical Aid in Dying Bill passed its Second Reading earlier this month.

HB 687 would require insurance coverage for the costs of medical transportation to the mainland. The bill has passed its Second Reading and is currently in the House Finance Committee.

Three bills to fund Emergency Medical Services have progressed in the legislature. HB 1676, HB 1790, and SB 2658 all appropriate an unspecified amount to the DOH for the purchase of ambulance vehicles and the operational costs for different counties. Both HB 1676 and SB 2658 are scheduled for Third Reading while HB 1790 has been referred to the House Finance Committee.