Tag: prescription drugs

House vote sends statewide PDMP proposal to Governor

      After roughly a decade of legislative consideration, the Missouri legislature has voted to create a statewide prescription drug monitoring program (PDMP).

Representative Travis Smith (Photo: Tim Bommel, Missouri House Communications)

      The program would consolidate information on the prescription of controlled substances so that pharmacists and physicians can identify those who might be dealing with addiction.  The House approved the bill, Senate Bill 63, 91-64, sending it to Governor Mike Parson (R).  Parson has signaled support for a PDMP.

      If SB 63 becomes law it would make Missouri the last state in the nation to enact a statewide PDMP.     More than 80-percent of the state is covered by a PDMP that began in St. Louis County a number of years ago.  This would replace that plan and have different requirements for the sharing of data.

      PDMPs are intended to identify and flag the practice of “doctor shopping,” when individuals go to multiple doctors and multiple pharmacists seeking to accumulate a large supply of a drug in order to abuse or sell it.  Supporters say the program will save lives and help get those with addictions into treatment.

      “Every law enforcement person I talked to, every doctor says it will prevent deaths in the future, and if you can prevent just one person from dying I think that means something.  I think this will prevent hundreds, if not thousands,” said Representative Travis Smith (R-Dora), who carried the bill in the House.   

      Opponents say PDMPs will create a database of Missourians’ private medical information which the government shouldn’t have.  Lake St. Louis representative Justin Hill, a former undercover drug enforcement officer, said PDMPs haven’t worked in other states and the one based in St. Louis County isn’t working.

Representative Justin Hill speaks against the PDMP proposal as Senator Holly Rehder, its sponsor, watches debate. (Photo: Tim Bommel, Missouri House Communications)

      “This has dire consequences.  The death rate in St. Louis County has actually increased because people are pushed away from pharmacies to buy their narcotics, which they are addicted to, on the street.  If you truly care about the lives of people that are addicted to these drugs then you want them to be discovered at the pharmacy.  You want them to doctor shop,” said Hill.  “You turn down that person at a doctor’s office or pharmacy, they’re still going to get their drug.”

      Smith said he’s heard those concerns, and if the bill becomes law he intends to monitor the impact of a PDMP in Missouri.  If it doesn’t work he will work to fix or eliminate it.

      “My argument to those people is this:  most heroin users did not start off as heroin users.  They had some kind of prescription for the opioid.  They get the opioid and because there wasn’t a monitoring program they got too much of it.  They got addicted,” said Smith.  “My idea is, if we can work with doctors and pharmacists and monitor it, we can catch it before it ever happens.”

      The bill passed the House with mostly Democratic support, with around 30 Republicans voting in favor.  Representative Tracy McCreery (D-St. Louis) has been in favor of a PDMP throughout her 8-year legislative career.

      She credited Senator Holly Rehder (R-Sikeston), who has sponsored and pushed for passage of a program through most of her 8 years in the House, and was the sponsor of SB 63.

      “I think that what her legislation is doing is truly putting a statewide PDMP forward, and to me that is something that is ultimately going to save lives.”

      Proponents say under SB 63, Missourians’ medical information will only be available to doctors and pharmacists.

Missouri House endorses statewide prescription drug monitoring program

The Missouri House has given preliminary approval to a statewide monitoring program for prescription drugs.  Supporters say it will combat abuse of prescription drugs.  Opponents say it will lead to more people switching to heroin and other illegal drugs, and cause an increase in overdose deaths.

Representative Holly Rehder (Photo: Tim Bommel, Missouri House Communications)

Missouri is the only state in the nation without a statewide program, though a program started by St. Louis County encompasses roughly 87-percent of the state’s population.

House Bill 1693 would replace St. Louis County’s program with one that covers all of Missouri and puts additional protections in place for those whose data would be in the Monitoring program.

It would create an online database that doctors and pharmacists could use to record and monitor the purchases of pills and visits to pharmacies.  For the seventh year, Representative Holly Rehder (R-Sikeston) is the proposal’s sponsor.  She said it would help fight what has been called an “epidemic” of prescription drug use.

“I ask that you all hear me say that this is not a silver bullet.  I have said that now for eight years, but as all states have said, this is a cornerstone in their fight against the epidemic,” said Rehder.

Representative Justin Hill (R-Lake St. Louis) has opposed creation of a Prescription Drug Monitoring Program (PDMP) each year he has been in the House.  He argues that such programs have not worked, and said by taking away pharmacies as places abusers can get prescription drugs the state would be pushing abusers to illicit drugs.  He said after St. Louis County’s PDMP was implemented the rate of drug overdose deaths increased in areas it covered.

“We’re okay with maybe putting another tool in the toolbox but at the expense of more lives.  I’m not okay with that,” said Hill.

Rehder acknowledged the increase in overdose deaths but maintained PDMPs are effective tools in detecting and stemming addiction before it worsens.

Representative Justin Hill (Photo: Tim Bommel, Missouri House Communications)

“What we’re trying to do is to stop band-aiding this epidemic.  We’re trying to work on the root of the problem, so we want to stop people from getting to that point,” said Rehder.

“As a grandmother who got my grandbaby out of a meth lab, who was living in one, there is no way that I would have the passion for this bill if I did not know from researching the data that this gets to the underlying problem,” said Rehder.  “We must stop addiction on the front end.  We must allow our providers to see it.”

Representative Glen Kolkmeyer (R-Odessa) said he backs the bill because not having a PDMP statewide means people can simply go to counties that do not have it to keep getting drugs to abuse or sell.

“My issue is … when we’re doing it patch quilted together is … if you’re from one county [which has PDMP] you’ll go to another county that doesn’t have it,” said Kolkmeyer.   “That’s why we need it statewide.”

Rehder said her bill includes protections against information in the PDMP database being used to take away Missourians’ rights under the 2nd and 4th Amendments.  She said those protections do not exist in the St. Louis County program.

Several proposed amendments to HB 1693 were voted down, including one that would have removed the bill from law if overdose deaths increase after its passage.

The bill was perfected by a roll call vote of 95-56.  Another favorable vote would send it to the Senate.

Missouri House sends prescription drug monitoring proposal to the Senate

The Missouri House has voted to create a statewide monitoring program for drug prescriptions.  Backers hope such a law would combat the abuse of prescription drugs and help prevent conflicts between medications.  Opponents say it would violate Missourians’ constitutional right to privacy.

Sikeston Republican Holly Rehder, who has pushed for a prescription drug monitoring program for years in response to her own family’s struggles with prescription drug abuse, hopes this is the year PDMP legislation is finally sent to the governor. (photo; Tim Bommel, Missouri House Communications)

House Bill 188 would create an online database that physicians and pharmacists could use to track pill purchases and pharmacy visits.  Missouri is the only state in the U.S. without such a system, statewide.  A program launched in the St. Louis region several years ago now covers 67 of the state’s 114 counties, encompassing about 87-percent of its population.

The bill cleared the House 103-53.  Republicans who opposed it were very vocal about fears that the program would create a government database that would jeopardize Missourians’ medical information.

Backers say no other PDMP database has ever been successfully hacked and say this would fall under Health Insurance Portability and Accountability Act privacy protections.  Blue Springs Republican Dan Stacy remained critical, and said that to say databases won’t get hacked is, “probably somewhat naïve.”

“The bigger the database, the bigger the target, and when we, as a body decide to put all of the State of Missouri – all of these records into one database – that is helping create a large target, and that is a place in which we can get a lot of data hacked because it’s a target,” said Stacy.

Eureka Republican Dottie Bailey said she remembered being a concealed carry permit holder when, under the administration of Governor Jay Nixon, information about those permit holders was shared with the Department of Homeland Security.

“Nothing has happened to that administration since that occurred other than my name is with the federal government as a firearms owner, or permitted, so right now, not a big deal, right?  But what happens when another administration gets in that wants to weaponize those databases?  And this is where I worry, this is where my constituents worry,” said Bailey.  “This bill is very difficult because yes, something needs to be done, but an overwhelming, sweeping government program has never, ever done what we think it’s going to do and then we usually end up regretting it.”

Proponents said concerns over privacy were being overblown, and paled in comparison to the bill’s goal of saving lives by fighting prescription drug abuse.

“Hacking is a real concern, I know, for all of us,” said Representative Sheila Solon (R-St. Joseph), “however we can’t let that worry consume us or we would never use a credit card to go to a restaurant or to go shopping or go to the gas station.  We’d never use a credit card or do any shopping online.”

Other lawmakers expressed frustration that all attempts to amend the bill were rejected.  Among those amendments were proposals to require physicians and pharmacists to participate in the database – the bill would make that optional – and to create penalties for failure to participate.

Representatives Justin Hill, Jack Bondon, and Jason Chipman were among those Republicans who opposed HB 188 to create a PDMP. Chipman offered an amendment to require all physicians and pharmacists in the state to participate in the program the bill would create, but it and all amendments to HB 188 were rejected. (photo; Tim Bommel, Missouri House Communications)

“No penalties; no requirement to participate; no protection for chronic pain patients, and that is unfathomable.  I just don’t get it, why we are punishing those who actually need the help,” said Ash Grove Republican Mike Moon.

Bill sponsor Holly Rehder (R-Sikeston) responded to those critics, saying, “I disagree with those who said that we didn’t do our job because this bill hasn’t been amended.  Mr. Speaker this bill has been massaged for years on this floor.  We started this year with where we had left off with the things we had agreed with.  The ones who wanted to amend it wanted to kill it.”

Rehder, who has proposed PDMP legislation for several consecutive sessions, told opponents that one way or another Missouri will have a monitoring program.

“Over half of our counties have passed this locally.  The current program will be statewide at some point and that program does not have legislative oversight; it doesn’t have a purge; it doesn’t protect our ability to purchase or have ownership of guns.  Do you need to pick which program you want?” said Rehder.

HB 188 now goes to the Senate, where past years’ versions have run into opposition and stalled out.  While the senator who led that opposition is no longer in that chamber due to term limits, last week the Senate version of Rehder’s bill stalled in a tie committee vote.

Rehder and other backers note that all members of that committee were present for the vote, and she believes that outcome isn’t representative of the chances of passing a PDMP bill this year.

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.