H.B. 264 Prescription Medication Amendments: transcript

Thank you Madam Chair and committee for your indulgence. This bill has just three small changes to pharmacy policy. I don't perceive any of them as large. Um, there are different ones. So one of them will just make it easier for patients to get things that have been prescribed to them for a bit longer period of time. If the prescriber orders it right now, even if a medicine is very safe and the prescriber writes refills 12 months and one day later you can't get those refills. This, this bill will just extend that out to a longer period of time. If the prescriber meant it, the patient could still get it for a longer period of time. Second is an update to a policy we passed a couple of years ago that would make it easier to substitute medicines when the prescriber wanted it to be substituted. Um, but right now there was a requirement in that initial bill that doesn't work well with our current medical records and so to a requirement to report back to the physician's office. And so this takes that requirement out. This thing only happens if the prescriber expressly goes out of their way to ask for it. So it would never happen on accident, but it just would make it easier for pharmacists to, to say, well, look, we can participate in the, the program. And then the third thing is we, uh, is just regarding standing orders where, where the, the state sets up standing orders. We've had those kind of be considered a lot more recently. And this just kind of lays out the reason why we do them. We do them when there is, um, a limited diagnosis that we say we're gonna make this medicine easier, LE available to people, but at the expense of cutting out a medical visit before it happens. So this just says it should be when it's a pretty straightforward condition. Um, and a clear cut reason then we'll is what? Those are the times when we want standing orders. And those are the policies in the bill. There is a first substitute that adds that third policy.

You. I just wanna make sure I understand this correctly. So if my doctor prescribes me medication and the pharmacy decides to substitute the medication, they don't have the,

So there are medicines that are very, very close to identical, but that the federal government refuses to identify as close enough for the pharmacy to substitute. Okay. Insulins is the best example. There are five forms of insulin glargine. There's Lar and Traba and Lantus that are all functionally the same. Every prescriber wishes they would be substituted when the insurance wants it, the other brand of it. But the pharmacies right now won't slash can't substitute it. Even if we, according to those normal rules, if the prescriber explicitly writes, not identical, but similar substitution authorized, they write that on the script. This just allows the pharmacy to then make that substitution per the instruction on the script.

Okay. Thank you.

Thank you, Madam Chair. Motion to adopt the first substitute and the sponsor's name

you wanna speak to it? I'll waive. I'll waive. Awesome.

Waive, go back to the maker of the motion. Waive. Waive.

So the, the motion is to fast forward first substitute or to, sorry. To adopt first substitute HB 2 64 with a favorable, or sorry, just to adopt the substitute.

Yeah. Motion to favorably recommend as substituted.

It's a good Bill. Sounds good.

Thank you Mr. Chair and Committee. Uh, this bill just has three small policy changes that I will make three small things better in the way that we do prescriptions and pharmacy. Um, and I'll just go through those. One of those is there are some prescriptions where it would be handy, both that the prescriber wants to, and the patient would like to receive a prescription that might be filled for longer than a year. Think of a prescription you get for cold sores in your mouth and you just need them once in a while. Um, not very often and, but there's a safe long-term medicine. It would be nice if the, you could write a prescription that would last longer than one a year. So a year later you're not forced to call back and say, oh, I need another visit just for this thing that we already agreed on. So this, the, the bill just says at the prescriber's discretion, uh, they, they can put refills on, they can limit 'em if they want to, but if they put prescription refills on, it can go for up to two years. And this is only for non-controlled substances. It's not for any addicting medicines. The second change relates to a policy that we passed a couple of years ago to make it easier to substitute, um, medications where the prescriber wants to substitute them. But because of federal rule, because they're very, very similar, but because of federal rules, the pharmacies still are not allowed to sub to substitute them. And we tried to pass a law that said if they're very similar and the prescriber writes that they want it done, then they could substitute across similar medications. And the state has created a list to make that happen. But the previous bill had a requirement in it that pharmacies notify physician offices back. And the software just doesn't allow that to happen. And so that's has made it so that the law hasn't really been able to be carried out. So this just eliminates that little requirement. If a prescriber, uh, doesn't want to do this, they still don't have to do it. Right? This only happens if they write the very specific words, similar substitution authorized. But we're hopeful that by taking out that requirement, it could allow, uh, this thing to happen. It would certainly be easier for patients and pharmacists and everyone if the first prescription was able to get the patient the medication that they needed. And the third change just relates to standing orders and it just clarifies, uh, for the department that we are gonna do standing orders only when the medicine is, um, FDA approved and for a particular, uh, diagnosis, a particular disease. We're not gonna have standing orders that are for many different diagnoses where in the pharmacy you're trying to figure out what, what the right diagnosis is. So it just puts that parameter and that fits with all the standing orders that we've done so far, but clarifies it and I'm happy to answer any questions.

Hi. Morning, Mary Ann Martindale, Utah Academy of Family Physicians. Um, sorry, we just wanna lend our support to this. This is, um, really great fixes for some of the things We've supported these, these certain elements in the past, but this allows for continuity of care and, and better access for, for prescriptions and things. So we just appreciate the sponsor for bringing these forward and cleaning this up. Thank you.

Thank you Mr. Speaker, uh, colleagues. This bill has, um, just a couple of small policy changes in it. The rate relate to how we do prescription drugs. Um, one policy will just make it easier for a prescriber, a physician or nurse practitioner to write a prescription that will last longer if that's what they want. Right now, if you write a prescription with refills, even if you meant for it to last longer, after a year goes by and even if you haven't used your refills, they will vanish off the, the pharmacy computer and you will have to call back to your provider's office. And typically you, you might have to make another visit, but if you agree that this is a safe, if both you working with your doctor agree this is a safe medicine, it would be fine for you to keep getting the refills for longer. This will allow that per period to go for two years, um, instead of one year. So just a little more convenient, it'll be nice for folks. The second policy that's in there is a slight improvement, I guess to a, a policy that we passed a couple years ago to make it easier for pharmacies to substitute medications in ways that the, the doctor wants, that the patient wants. But that the federal government has not got its act together. So even when you try and ask them to substitute it, it still doesn't happen. And the policy we passed before allowed us to write for a similar substitution instead of just an identical one. Um, but the previous policy required the pharmacy to notify back to the doctor's office and the software just doesn't do that. So the policy has not really been able to work in the broader community. And so this would just removes that notification back to the physician's office that this thing only happens if you expressly write similar substitution authorized on the prescription. So it's never gonna happen by accident, but hopefully it will make it easier for that to happen. And the third policy just relates to how we do standing orders, uh, in the Department of Health to say that those are for, um, a, a single clinical purpose. Um, and, and it needs to be an FDA approved purpose. And that's the three policy changes in the bill. Thank you.

Thank you Mr. Speaker. Will the sponsor yield to a question? Representative Ward, will you yield to a question? Yes, Yes. Represe representative. Thank you. And I appreciate his expertise in this area. Just have a question. Um, if someone say, has like a chronic condition that may need an annual physical or review, does this bill give flexibility there? Is it pushing everything to two years? Can he speak more to that process and how a provider would come to that conclusion?

Thank you for that question. That's a good question. So for most chronic, uh, medications where, especially where it's a medicine that the person takes, um, every day, then you would write a number of pills that really only added up to one year. So you would say, here's here's a 90 day supply and I put three more refills that only adds up to one year. Then you cannot fill any more than that number of fills. So that one where the intention was that you followed up in a year, you'd write it in a way that it went one year and then you had to follow up again. But if, uh, you were riding like seasickness patches so you could grow on your cruise and you didn't know yet if you were gonna go on your cruise and it was really okay with the prescriber, if a year later you still filled those patches one more time to go on a cruise next year, then you could write it that you wouldn't have to go back in that sort of a case.

Thank you, Mr. Speaker. So just to be clear, the discretion is still up to the provider.

100%. Thank you.

Waive. Thank

that certain medications can be therapeutically, uh, substituted. And there is an amendment online. It's amendment number one in my name that makes a small change. A clarification change on line 66. So with your permission, Mr. President, I would like to move that amendment, amendment number one in my name.

Yeah, we're trying to make sure it's clear how the process would work for when a physician writes a prescription and how the pharmacist is clear that he can have or he or she has the authority to make that substitution.

Thank you Mr. President. Yeah, the bill makes three small policy changes, uh, makes it easier for a prescriber to, uh, write a prescription. They will last longer than if they would like. So currently under, uh, state law, the, if a prescription is written for a legend drug, so a legend drug is a prescription. A prescription drug, one that requires a prescription federally requires a prescription, but is not a controlled substance that can be written and refilled for up to a year. So for, for example, if you receive a prescription for a blood pressure medication, it would fall into this category. If the physician puts on the, the adequate refills, then it could be filled up for a year. Um, this change would allow on the physician to indicate that it's good for two years instead of just one. So that's a clarification. And like I say, this would be only be on non-controlled substance maintenance medications. The second change is a slight improvement. The policy we passed a few years ago, that makes it easier for, for pharmacies to substitute medications in ways the doctor and patient wants. We're clarifying how that can be done, you know, in the language or particular, uh, language that would have to be on the prescription to allow that to take place. And then the third policy, it relates to how we do standing orders in the Department of Health. And to say those are for single clinical FDA approved purpose. Currently in the state of Utah, we do have a process where under certain circumstances there's only a, there's only a few that have risen and Naloxone is one. Um, glucagon for diabetics is another. Uh, vaccines, those types of things have risen to the level where you can have a standing order from a doctor within the Department of Health and Human Services that a pharmacy can use as authorization to fill a prescription for that patient. This clarifies that policy that it has to be something that is for, it's been diagnosed for that particular maldy that is FDA approved and it meets all those CRI criteria then that there, there could potentially be a standing order here again, there would only be, there's not going to be many, but does clarify that the criteria for requesting a standing order. So with that, Mr. President pro tem, I am hoping for questions, Questions or debate to the bill.

Seeing none, Senator Rickers, I would waive summation and move that first substitute house bill 2 64 as amended. Be read a third time.

Senator Spery Lewin Brammer. I said That Bus colmore as Camilla Aye. Fillmore Aye. Grover Harper Kins Aye. Sson Aye. Johnson Aye. Juab McKay? Aye. Mikel Milner Musselman Owens Owens pitcher Plum Rebi Aye. Sandal Stevenson Stratton stickers. Aye. Weiler Aye. Wilson. Aye. Winterton Lewin Aye.

Thank you Mr. President. Uh, this bill is working with substitution of Therapeutic Equivalent Medications in a pharmacy working with the the Good House sponsor. Over the last couple of years, we've tried to make it clear, especially with especially drugs and, and we're looking to make just a few small changes here. The first policy is just makes it easier for prescriber, uh, to write a prescription that'll last longer. So think of your blood pressure medications and maintenance medications could be, uh, issued for as long as two years instead of just one year. Currently, uh, as long as there's enough refills on the prescription and the pharmacist could continue to refill that for two years. Uh, the second change is a slight improvement of the policy that we worked on, uh, in that this has to do with substitution of therapeutically equivalent products. And then the third policy relates to a standing order clarifying. Currently we can do a standing order with a, a doctor in the Department of Health and pharmacies can fill off of that. We've only had a few things rise to that level. Naloxone, uh, glucagon vaccines, things like that. This just clarifies what the criteria would be for a standing order moving forward. So with that, I'm open for any questions.

Thank Mr. President. I would waive, uh, summation and move the first substitute hospital 2 64 pass. Thank

Senator Vickers Baldy Aye. Lewin Brammer Aye. Bus Cullimore. Escamilla Fillmore Grover Aye. Harper Aye. Kins Aye. Ipson Aye. Johnson Kwan McKay Mikel Aye. Milner Musselman Owens pitcher Plum Rebi Sandal Stevenson Stratton Bickers Aye. Weiler Aye. Wilson Winterton Aye.

President Adams Aye. First substitute house Bill 2 64.

Thank you Mr. Speaker. Motion to concur with the Senate amendments.

Uh, yes, briefly. Um, this is a bill about substituting medications at the pharmacy. Um, and it came to light that the, what we were trying to get at in some other states had a different, slightly different term that was used. And so just to make it easier, uh, for everyone to know what we were talking about, we decided to add that term also to the bill, um, as a way that the prescriber could communicate to the pharmacy that they wished for this kind of substitution to happen with their medications.

It's a honor representative seeing all President having voting.