House approves bill backers say would reduce prescription drug costs

The Missouri House has approved a bill that backers say will save Missourians money on prescription drugs.

Representative Lynn Morris (photo; Tim Bommel, Missouri House Communications – click for larger version)

The sponsor of House Bill 1542, Representative Lynn Morris (R-Nixa), has been working at his pharmacy since 1977.  He said what many don’t know is that pharmacy benefits managers have pharmacists sign agreements that prevent them from telling customers when a drug’s out-of-pocket cost is less than the copay on their insurance plans, unless the customer asks about it.  Morris said that almost never happens because customers assume the cost through their insurance plans or networks will be the cheapest to them.

HB 1542 would eliminate those agreements, which Morris called, “gag orders.”

“Pharmacists want to tell the patient how to save money.  It’s extremely important to pharmacists to help those people,” said Morris.  “We owe it to our customers, we owe it to our patients, to always give them the best price, and these PBMs have forced us not to do that.”

Representative Tracy McCreery (photo; Tim Bommel, Missouri House Communications – click for larger version)

The bill was broadly supported, having been sent to the Senate on a 138-7 vote.  Representative Tracy McCreery (D-St. Louis) said there should be nothing keeping pharmacists from being up front with customers.

“This bill is actually one of them that goes straight to the heart of addressing concerns that a lot of our constituents have, which is the rising costs of prescription drugs, and what they need to do in order to use their money most efficiently,” said McCreery.  “Pharmacists are a trusted profession – poll after poll shows that – and I think it’s shameful that pharmacists have been put in a position where there’s a gag order and they’re unable to capitalize on that trusted position.”

Morris said pharmacists agree to these “gag orders” as part of the contracts they sign with those managers.  Without signing such a contract a pharmacist cannot participate in the insurance programs handled by that manager.  He said that’s an issue for any pharmacist, but it’s especially critical for rural pharmacists, for whom the loss of any part of a customer base could mean closing the business.

Other provisions in HB 1542 would bar benefits managers from charging what Morris called “clawback” fees, or any fees related to a claim that has not been disclosed up front.  It would also prohibit benefits managers from keeping pharmacists from making statements to government officials or committees.

HB 1542 has been sent to the Senate.  Morris said similar legislation has been passed in other states or is pending.

House prepares extensive foster care reform legislation

An increased focus on issues concerning foster care in Missouri has resulted in a bill containing 11 different reforms meant to make life better for children who are in, and who leave, that care.

Representative Jim Neely chairs the House Special Committee to Improve the Care and Well-Being of Young People and sponsors HCB 11, a comprehensive foster care reform bill. (photo; Tim Bommel, Missouri House Communications – click for larger version)

House Speaker Todd Richardson (R-Poplar Bluff) in January created the Special Committee to Improve the Care and Well-Being of Young People to focus on improving the state’s child welfare system.  That committee is chaired by Cameron Representative Jim Neely (R), who selected 11 of the bills assigned to it to be combined into House Committee Bill 11.

Neely, a doctor, said improving the lives of children has been his priority since a young girl who’d been abused came into his office about ten years ago.

“This young lady said a lot of adults had let her down, and so I chewed on that and thought about life and what I needed to do, and that was probably the seed that caused me to run for office a few years later,” said Neely.

Neely said some of the things HCB 11 would change in Missouri law are “quick” or “simple” fixes that could have significant impacts, especially in situations in which foster children have been described as, “falling through the cracks.”

“There’s an incident in the Kansas City area where a child was over in Kansas and if we’d been able to share information with the State of Kansas we might have been able to prevent a horrid situation over there,” said Neely.  “We’re just trying to make [things] a little more user friendly and get the foster parents a little more safety net.”

HCB 11 includes language that would update background checks on foster families so that the Children’s Division would know immediately if a foster parent is charged with a crime that would disqualify him or her from being a foster parent.  Current law only allows checks every two years.

Representative Sonya Anderson (photo; Tim Bommel, Missouri House Communications – click for larger version)

That portion of the bill came from House Bill 1944 sponsored by Representative Sonya Anderson (R-Springfield).

“House Bill 1944 would allow the Department of Social Services to utilize the RAPBACK program, which is the Record of Arrest and Prosecution, and so it’s a more instant update if a foster care parent or someone who resides in the house has been charged with a crime,” said Anderson.  “We want to make sure that [foster] children are in the safest environment as possible.”

HCB 11 would also expand assessment and treatment services for children in foster care.  It would require such services for all children in foster care – currently it is required only for those under the age of ten – and would require that those services be completed in accordance with the American Academy of Pediatrics’ periodicity schedule.  Currently children are screened every two years.

The original sponsor of that language is Representative Lauren Arthur (D-Kansas City), who said it would ensure that children in foster care receive more appropriate care, and the comprehensive screenings will in turn save the state money by catching medical conditions earlier and aiding in preventative care.

Representative Lauren Arthur (photo; Tim Bommel, Missouri House Communications – click for larger version)

“This would change the requirements so that every child in foster care is receiving these kinds of screenings, not just children under the age of ten.  Additionally it means that they’ll receive more appropriate care, so according to the experts – the American Academy of Pediatrics – our children in foster care will go to the doctor according to their recommendations and that schedule as opposed to the legislature saying they have to go every two years,” said Arthur.  “For older kids in foster care, often when they are pulled out of school more than their peers it adds to a feeling of stigma – they feel like they’re different from their classmates – and we certainly don’t want them to feel different or have to go to the doctor more than anyone else just because they’re in foster care.”

Another portion of HCB 11 comes from House Bill 1862 sponsored by Representative Phil Christofanelli (R-St. Peters).  It would enable investigations of abuse of children in foster care in Missouri when it happens outside of the state.

Current law prevents Missouri Social Services workers from investigating reports of abuse of Missouri children in foster care if the abuse doesn’t occur in Missouri, and prevents them from communicating with counterparts in other states about abuse or potential abuse.  Christofanelli said his bill would remove those barriers and fix what he called a, “bureaucratic technicality.”

“This is just eliminating some loopholes that have resulted in some unfortunate situations in the past and making sure that we have full communication across state lines to protect kids,” said Christofanelli.

He said HCB 11 is combining a number of efforts to fix situations in which lawmakers are told, all too often, that children are being “left behind.”

Representative Phil Christofanelli (photo; Tim Bommel, Missouri House Communications – click for larger version)

“It’s one of the most rewarding parts of being in the legislature and it’s such an easy fix.  It’s shocking to me that this hasn’t been done yet because we’ve seen case after case where problems like this arise across state lines,” said Christofanelli.  “Our kids are our greatest asset here in Missouri and if there’s anything that we can do to help keep them safe then we’re going to do it as the legislature, so I’m honored to be a part of that process.”

Some lawmakers expressed concerns with the portion of the bill because other states might release information about abuse claims – particularly unsubstantiated claims – that Missouri would not release.  They expressed a desire to see that concern addressed before the bill could become law.

The House is prepared to vote on whether to send HCB 11 to the Senate.  The bill is broadly supported, including by Columbia Democrat Martha Stevens, who sits on the Special Committee to Improve the Care and Well-Being of Young People.

Stevens said she’s glad to be on the committee but says it has more work to do even if HCB 11 becomes law, “particularly with children aging out of the foster care system, so I’m hopeful that in the interim, with stakeholders and advocates and experts and folks on both sides of the aisle we can bring forward more solutions next year to help address issues around foster care and support the Missouri youth that are aging out of foster care.”

      Other parts of HCB 11 would:

– Provide free birth certificates to children in foster care, making it easier for them to become independent (found in House Bill 1470 sponsored by Representative Mike Kelley, R-Lamar)

– Allow more time for a case management plan to be developed for a child entering foster care (found in House Bill 1637 sponsored by Representative Neely)

– Allow foster children aged 16 years and older to open a checking or savings account with the consent of the Children’s Division or juvenile court, giving them the ability to cash paychecks and better access to jobs  (found in House Bill 1715 sponsored by Representative Don Phillips, R-Kimberling City)

– Make closed under law any records regarding placement of children into foster care or kinship placements, and specify who can access those records and when (found in House Bill 1966 sponsored by Representative Robert Cornejo, R-St. Peters)

– Allow a child who is homeless or in the custody of the Children’s Division, but the whereabouts of his or her immunization records is unknown, to be enrolled in school for up to 30 days while efforts are made to find those records, and if needed, another 30 days after that for the child to get caught up on immunizations (found in House Bill 2139 sponsored by Representative Lynn Morris, R-Nixa)

– Define when juvenile courts have jurisdiction over a child under 21, streamlining situations in which a child is in a safe situation but juvenile court involvement is interfering with the family (found in House Bill 1728 sponsored by Representative Bill Lant, R-Pineville)

– Establish guidelines for educating children in court-ordered group homes or institutions for delinquent or neglected children (found in House Bill 2625 sponsored by Representative Lyle Rowland R, Cedarcreek)

– Create the “Trauma-Informed Care for Children and Families Board” to encourage cooperation between agencies that deal with children and utilize trauma-informed treatment programs (found in House Bill 2217 sponsored by Representative Cora Faith Walker, D-Ferguson)

House perfects prescription drug monitoring program proposal

The Missouri House has given initial approval to a proposed tracking system for prescription drugs that backers hope will fight opioid abuse in Missouri.  Specifically it aims to help stop “doctor shopping;” the practice of going to multiple doctors seeking multiple prescriptions for valuable and addictive medications.

This is the fifth session in which Representative Holly Rehder has sponsored PDMP legislation.  (photo; Tim Bommel, Missouri House Communications)
This is the fifth session in which Representative Holly Rehder has sponsored PDMP legislation. (photo; Tim Bommel, Missouri House Communications)

House Bill 90 would make Missouri the 50th state to enact a prescription drug monitoring program (PDMP).  The electronic registry would take information on those who prescribe, use, or dispense prescription drugs.

The bill had bipartisan support in a 109-40 voteWest Plains Republican Shawn Rhoads, a former police detective, said it is an answer to opioid abuse in Missouri.

“There’s just so many times in a career [someone has] had to go to somebody’s house and tell them that their loved one has overdosed and died because somebody was doctor shopping, selling them drugs, and they’ve overdosed on them.  That is the worst thing that you will ever have to do in a career, and I’m telling you I never, ever, want to do it again,” said Rhoads.  “That’s why, Mr. Speaker, I urge the body to vote for this bill.”

The bill is sponsored by Sikeston Republican Holly Rehder, who has spoken publicly many times about her own family’s experience with addiction.

“I grew up in poverty.  One of my stepdads was a dealer.  My sister married a dealer at 16, was a main line user by the time she was 16,” said Rehder.  “I didn’t use drugs because I was afraid of them.  I saw what they did to those around me.”

Rehder said it was that fear that caused her to raise her children “differently,” but when her daughter was given a prescription for opioid painkillers after cutting her thumb at work, she became addicted.

“From that point forward we had 13 years of addiction,” said Rehder.

Rehder said addictions to opioid painkillers often begin with a legal prescription following an injury, such as when a high school athlete gets hurt.

“An athlete breaks a leg or whatever, they go to the doctor, they get an opiate to help with the pain, and then if that person is predisposed to addiction, they become addicted.”

Before giving the bill first-round approval, the House changed it so that by 2020, pharmacists will have to report information to the registry in real-time.

The sponsor of that change, Representative Lynn Morris (R-Nixa), owns a chain of pharmacies.

“By doing real-time, all my stores are connected real-time, and we know how much importance that is in trying to catch people that are drug shopping every day, and we catch them and we don’t fail to catch them,” said Morris.

Opponents say a PDMP creates a government database and poses a threat to the privacy of anyone using prescription drugs.

Representative Rick Brattin was among those Republicans who opposed the PDMP legislation filed by one of their fellow caucus members.  (photo; Tim Bommel, Missouri House Communications)
Representative Rick Brattin questioned the PDMP legislation offered by a fellow Republican, but voted for the bill on perfection. (photo; Tim Bommel, Missouri House Communications)

Harrisonville Republican Rick Brattin also argued PDMPs must not be effective because they exist in all other states, yet President Donald Trump has launched a task force to fight opioid addiction.

“So that would lend to me that this sort of program does not work and it has no effect, and if it has we would not be issuing a task force for the entire country to tackle the overprescribing of opioids,” said Brattin.

Ash Grove Republican Mike Moon also maintains PDMPs are not effective, and urged his fellow lawmakers to consider whether Missouri should launch one.

“As of 2014 Missouri ranked 24th in the nation related to the number of deaths due to prescription drug overdose, and we’re not participating in the PDMP.  You’d think that Missouri would be number one in the abuse category, but we’re not,” said Moon

Brattin and others offered other changes to HB 90 saying it needed to be strengthened, in part because similar versions have stalled in the state Senate in past years.  Rehder urged legislators to reject them, saying that over the five years she’s handled the issue, stakeholders including law enforcement and medical experts have helped develop the language she’s proposing.  Those amendments were then rejected.

Another favorable vote would send the bill to the Senate, where in past years it has been stopped primarily by Senator Rob Schaaf (R-St. Joseph), who has his own PDMP proposal which cleared that chamber early this month.