MPARX

Maine Pharmacy Association

2017 Scholarship Golf Scramble

Join us for our 2017 Scholarship Golf Scramble ! Where: Val Halla Country Club When: Saturday, August 12, 2017 Shotgun start 1pm Includes 18 holes of golf on a championship course, golf cart, BBQ dinner at Rachel’s on the Green! Cost: Single Golfer: $110.00 Foursome: $400.00 Dinner Only: $35.00 Corporate or personal hole sponsorship: $75 […]

LD6 and LD44 Are Successfully Moving Through the Legislative Process

Good news!!  Two bills, LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies” and LD 455, “An Act Relating to the Provision of Smoking Cessation Services by Pharmacists” are moving through the legislature process. LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on […]

Achievement Award Nominations

MPA would like your assistance in nominating persons worthy of these honors to be recognized at the Sesquicentennial Awards Ceremony at the Holiday Inn By the Bay, October 13-15, 2017.  To nominate a person, please complete the nomination form and submit by June 1, 2016. MPA Award Nomination Form **NEW** Douglas H. Kay Distinguished Pharmacy Educator Award Sponsored […]

IMPORTANT Augusta Legislative Update – Time to Advocate!

NOW is the time to advocate for your profession!  Details about how YOU can get involved are outlined below. I’m delighted to report that a date for a public hearing has been set for LD 572, An Act to Amend the Laws Governing the Practice of Pharmacy, and LD 456, An Act to Increase Access to […]

CDC OPIOID PRESCRIBING GUIDELINE MOBILE APP

Opioids can have serious risks and side effects, and CDC developed the CDC Guideline for Prescribing Opioids for Chronic Pain to encourage safer, more effective chronic pain management. CDC’s new Opioid Guideline App makes it easier to apply the recommendations into clinical practice by putting the entire guideline, tools, and resources in the palm of […]

Good news!!  Two bills, LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies” and LD 455, “An Act Relating to the Provision of Smoking Cessation Services by Pharmacists” are moving through the legislature process.

LD 6, an “An Act to Prohibit Insurance Carriers from Retroactively Reducing Payment on Clean Claims Submitted by Pharmacies” has passed the Maine Senate and Maine House and is on the way to the Governor’s desk.   The Maine Pharmacy Association advocated for this bill.

What are Retroactive Payment Reductions?  In theory, calculating the profit from dispensing a prescription should not be difficult.  However, retroactive payment reductions such as Direct and Indirect Remuneration (DIR) fees are complicated charges that are billed to pharmacies often many months after a clean claim for a prescription has been submitted.  These charges may be the difference between the agreed upon reimbursement rate and another contractual variable or these fees may be based on compliance with contractually imposed performance metrics.  These retroactive fees, which began as a component of Medicare Part D plans, have expanded and are now incorporated in many commercial third party plans.
 
How does this affect pharmacy?
“DIR fees have wreaked havoc on independent community pharmacies and their ability to continue serving patients. These fees, typically assessed by PBMs well after prescriptions are dispensed to patients, blow a hole in community pharmacy operating budgets that is difficult to mend,” Doug Hoey, CEO of NCPA January 20, 2017
 
The growth in DIR fees is outpacing the growth of part-D drug costs and DIR fees have expanded to many commercial third party plans.  DIR fees have yet to show that they improve performance and specifically patient outcomes.  DIR fees do not reduce the cost of drugs for beneficiaries at the point-of-sale and in fact push seniors (especially vulnerable patients who use the prescription drug benefit the most) into the ‘donut hole’ and even further into the catastrophic phase of the Part D benefit.  As implemented, DIR fees are shifting the burden of drug costs away from the private insurance companies and onto the backs of local pharmacies.   LD 6 is a win for the profession because it requires fair reimbursement for clean pharmacy claims.

LD 455, “An Act Relating to the Provision of Smoking Cessation Services by Pharmacists” received a unanimous ‘ought to pass’ as amended from the Health and Human Services Committee.  The amended bill would add the following to the definition of “Practice of Pharmacy”… “the provision of tobacco cessation, ordering and dispensing of over-the-counter tobacco cessation products approved by the United States Food and Drug Administration”.

This bill is good public health policy because it increases access to smoking cessation products and services. A unanimous ought-to-pass from the committee is a significant step forward in the legislative process.  We’ll continue to monitor this bill through the legislature and to the Governor’s desk.

NOW is the time to advocate for your profession!  Details about how YOU can get involved are outlined below.

I’m delighted to report that a date for a public hearing has been set for LD 572, An Act to Amend the Laws Governing the Practice of Pharmacy, and LD 456, An Act to Increase Access to Vaccinations.  
 
JOINT STANDING COMMITTEE ON LABOR, COMMERCE, RESEARCH AND ECONOMIC DEVELOPMENT
Sen. Amy Volk, Senate Chair & Rep. Ryan Fecteau, House Chair 
PUBLIC HEARING: Tuesday, March 07, 2017, 1:00 PM, Cross Building, Room 208
 
NOW is the time to recognize pharmacists as Providers of Health Care Services!
 

LD 572 amends the definitions of “Pharmacist” and “Practice of Pharmacy” to specify that our profession provides health care services.  Every day, pharmacists across our state educate patients on the safe use of medications, immunize against vaccine-preventable diseases, provide comprehensive medication reviews to seniors, and reduce the risks of medication adverse events thereby lowering total healthcare costs.  LD 572 recognizes the role of pharmacists in today’s healthcare systems.  LD 572 formally defines what is already a fact; pharmacists are “Providers of Health Care Services” and members of the healthcare team.  LD 572 has bipartisan support; sponsored by Senator Volk  of Scarborough and co-sponsored by Representative Fecteau of Biddeford, Senator Brakey of Androscoggin, Senator Katz of Kennebec, Representative Perry of Calais, and Representative Chace of Durham.  With both accredited colleges of pharmacy in Maine training Doctor of Pharmacy graduates, now is the time to recognize the contribution of pharmacists to patient careMaine 128_LD 572 Practice of Pharmacy       

 
LD 456 expands access to vaccination services for teens and preteens by allowing the administration of certain vaccines by a pharmacist to a person 11 years of age and older, instead of 18 years of age and older as in current law.  The CDC routinely recommends the HPV vaccine to prevent certain cancers, the Tdap booster, and the meningococcal vaccine to persons in this age group.  LD 456 is good public health policy for 3 reasons.  1) Maine has the lowest vaccination rate of Tdap (87.7%), meningococcal (77.7%), and HPV (53.9%, >2 doses) of all New England states(1).  The recent pertussis outbreak in Maine with a peak of 557 cases in 2014 is a powerful reminder that infectious diseases can gain ground at any time, unless we remain vigilant(2).  2) Pharmacists are the most accessible healthcare professionals.  Over 1,000 pharmacists have been trained and registered as immunizers in Maine.  Pharmacist immunizers are located in every county of our state and offer vaccination services in underserved, rural communities.  Many pharmacies offer vaccination services on a walk-in basis during days, evenings, and weekends.  3) Lastly, LD 456 ensures pharmacists work in collaboration with the child’s physician.  LD 456 and existing regulations require a prescription or standing order for Tdap, Meningococcal or HPV vaccines prior to pharmacist administration.  LD 456 and existing regulations also require the pharmacist to notify the authorizing practitioner (of the vaccine administration) who issues the prescription or standing order within 3 business days.  This bill ensures that pharmacists work collaboratively on healthcare teams to ensure appropriate immunizations. Maine 128_LD 456 Access to Vaccinations
 
What can YOU do to advocate for pharmacy?
1) Attend the public hearing on March 7th.  Bring a patient advocate, bring a medical colleague, bring your APPE students (in their white coats).  
2) If you can’t attend in person, send me your testimony of support (template letter attached) and I’ll submit your testimony on your behalf at the public hearing.
 
Pharmacy needs to STAND UNITED for this hearing and show our commitment to public policy solutions that optimize care for patients.  We need at least 30 pharmacy students in white coats at this hearing.  We need pharmacists from a variety of practice settings to testify their support.  We need at least 100 letters of support from pharmacists across the state.
 
 
Thank you for your commitment!  Please feel free to contact me with questions.
 
 
Best regards,
 
Mac

Opioids can have serious risks and side effects, and CDC developed the CDC Guideline for Prescribing Opioids for Chronic Pain to encourage safer, more effective chronic pain management. CDC’s new Opioid Guideline App makes it easier to apply the recommendations into clinical practice by putting the entire guideline, tools, and resources in the palm of your hand.

Since 1999, the amount of prescription opioids sold in the U.S. has nearly quadrupled.

FEATURES INCLUDE:

  • Patients prescribed higher opioid dosages are at higher risk of overdose death. Use the app to quickly calculate the total daily opioid dose (MME) to identify patients who may need closer monitoring, tapering, or other measures to reduce risk.
  • Access summaries of key recommendations or link to the full Guideline to make informed clinical decisions and protect your patients.
  • To provide safer, more effective pain management, talk to your patients about the risks and benefits of opioids and work together towards treatment goals. Use the interactive MI feature to practice effective communication skills and prescribe with confidence.

MANAGING CHRONIC PAIN IS COMPLEX, BUT ACCESSING PRESCRIBING GUIDANCE HAS NEVER BEEN EASIER.

Download the free Opioid Guideline App today!  CDC Drug Overdose Prescribing APP

This App, including the calculator, is not intended to replace clinical judgment. Always consider the individual clinical circumstances of each patient.

LEARN MORE
www.cdc.gov/drugoverdose/prescribing/guideline.html |

The Department of Health and Human Services has released a communication concerning the implementation of DHHS rule to carry out the requirements of PL 488.  DHHS has collaborated with stakeholders to assist the department to improve the program and policy regarding opioid medication practices here in Maine. It is the hope that this communication will serve to calm some of the apprehensions around the DHHS rule.  The Maine Pharmacy Association will continue to communicate information as it becomes available.

 

Click Here for Letter

Please verify your PMP account information by end of business November 30, 2016 to ensure a smooth transition to the new software system in mid December.  Please read the letter from Sheldon Wheeler outlining the new system requirements and transition plan.


 

Dear Account Holder:

The Maine Prescription Monitoring Program (PMP) will be upgrading software systems to meet the required PMP enhancements identified in Chapter 488 Public Law. The Department will be moving to the new software on Tuesday, December 20, 2016. Please find important information about the upcoming transition below.

In the new system, only one user account is allowed per email address. All accounts that share an email address MUST provide a unique email address for each user moving forward, or they will NOT be transferred to the new system. If your account is not transferred, you will have to submit a new registration application and wait for your account to be approved by the state administrator.

To ensure your account is successfully transferred to the new system, please verify that the email address listed on your account is unique. Log in to your existing account at

https://mepdm-ph.hidinc.com/melogappl/bdmepdmqlog/pmqhome.html to review and update your profile.

Please complete all account updates by the end of business on Wednesday, November 30, 2016.    

Additional login information and the user guide will be forthcoming. 

Please be aware that there will be a delay in prescription history of up to 2 weeks during the transition. We appreciate your understanding and patience during this time.

Should you have any questions at this time, you may contact the Maine Prescription Monitoring Program at (207) 287-2595 or by email at SAMHS.PMP@maine.gov.

Best Regards,

Sheldon Wheeler

Director, Office of Substance Abuse and Mental Health Services

 

CC:

Evelyn Sharkey, PMP Coordinator

Jessica Bates, PharmD,  shared a summary document regarding the new opioid prescribing laws in Maine.  It is a document created for providers with suggestions for compliance.

Please click here for the summary.

Thank you Jessica.

 

Maine’s new opioid prescribing and PMP law takes effect July 29th, though some provisions have other timeframes specified in the law.  The impact of this law will significantly affect prescribers, pharmacists and patients.  Here’s an essential update:

Penalties

Individuals who violate this law (prescribers and pharmacists) may be subject to civil penalties of $250 per violation, not to exceed $5000 per calendar year.

 

Limits on Prescribing

Effective 7/29/16 – Limits new opioid prescriptions, or an aggregate of multiple opioids prescriptions, to no more than 100 morphine mg equivalents (MMEs) per day.  Visit the Maine Quality Counts Caring for ME webpage for information on compassionate tapering of opioids.

 

Effective 7/29/16 until 7/1/17 – For patients who already have active prescriptions that exceed 100 MMEs per day, opioids prescriptions must be limited to 300 MMEs per day, in aggregate.

 

Effective 7/1/17 – New and existing prescriptions for opioid medications are limited to 100 MMEs per day.

 

Exceptions

  • Medical necessity that is documented in the patient’s record.  This expires 1/1/17.
  • Cancer pain
  • Palliative care associated with a serious illness or injury.
  • End of life and hospice care
  • Medication-assisted treatment for substance abuse disorder
  • Opioids directly ordered or administered in an emergency room, hospital, long-term care or residential treatment facility.
  • Or other circumstances to be defined in rule by 1/1/2017.

 

Effective 1/1/17 – Opioid prescriptions for acute pain limited to 7 day supply within a 7 day period (renewable).  Opioid prescriptions for chronic pain limited to a 30 day supply within a 30 day period (renewable).

 

Prescription Monitoring Program

Effective 1/1/17 – Prescribers must check the PMP upon initial prescription of a benzodiazepine or an opioids, and every 90 days thereafter for as long as the prescription is renewed.  This provision does not apply when a benzodiazepine or opioids is ordered or administered in an emergency room, a hospital, a long term care facility or a residential care facility.

 

Effective 1/1/17 – Pharmacists must check the PMP prior to dispensing a benzodiazepine or opioids under the following circumstances:

  1. A person is not a resident of Maine
  2. The prescription is from a prescriber with an address outside Maine
  3. The person is paying cash when the person has a prescription insurance on file
  4. According to the pharmacy record, the person has not had a prescription for a benzodiazepine or an opioids medication in the previous 12 months.

 

o   Requires that pharmacists notify the program and withhold a prescription until the pharmacist is able to contact the prescriber if the pharmacist has reason to believe that the prescription is fraudulent or duplicative.

o   Allows on-duty pharmacists to authorize staff to access the PMP for customers filling prescriptions.

 

The Maine PMP is making efforts to automatically register pharmacists into the system in conjunction with annual license renewal.  However, there’s no guarantee this will be done in time for January 2017.   As of July 2016, only half of Maine pharmacists are registered with the PMP.  Don’t wait, register now.

 

Pharmacists, register with the PMP here.

 

Pharmacy Technicians, register as a sub-account here.

 

Electronic Prescribing

Effective 7/1/17 – All prescribers must prescribe opioids electronically.  A waiver from DHHS must be requested if compliance cannot be met.

Of note – New York was the first state to require electronic prescribing of controlled substances.  Maine will be the second state.  As of July 2016, 94% of pharmacies and 4% of physician practices in Maine are equipped to electronically transmit controlled substance prescriptions.  If you are uncertain if your pharmacy is equipped, contact your pharmacy operating system vendor.  Arrange with your vendor for a demo, timeframe for installation, training and pricing.

 

Education

Effective 12/31/17 – All prescribers of opioid medications must complete 3 hours of CME on opioids every 2 years.

 

 

Best regards,

Mac

We’re one step closer to advancing pharmacy practice in Maine!  The proposed rule-making for Collaborative Drug Therapy Management is now available.    Please review the Proposed Rule-making CDTM Document and share your thoughts to MPARXinfo@gmail.com by December 31, 2015.   MPA will collate all comments into a letter to the Board by the comment deadline of January 4th.

HR 592/S314 “Pharmacy and Medically Underserved Areas Enhancement Act” is one of the most important legislative initiatives for the profession of pharmacy. HR 592 and the Senate companion bill S314 would amend Title XVIII of the Social Security Act to include pharmacists as providers thereby enabling patient access to, and payment for pharmacy services.  Currently, there are 185 cosponsors in the House of Representatives for HR 592 and 28 cosponsors of S314 in the Senate. Representative Pingree and Senator Collins have already pledged their support to the bill.

 

Recently, a delegation from Maine Pharmacy Association met with legislative staff at Representative Poliquin’s office in Lewiston to advocate for this important legislation. The visit concluded by asking Representative Poliquin to support patient access to cost-effective pharmacy services and to cosponsor HR 592. The MPA delegation will be meeting with Senator King’s office later this month.

 

Poliquin

From left to right: Kenneth McCall, PharmD, Associate Professor UNE, Cassandra White, PharmD, Assistant Professor, Husson University, Amelia Arnold, PharmD, Manager of Retail and Clinical Operations, Community Pharmacies, Erin Kany, UNE Class of 2017, Stephanie Lewis, PharmD, UNE-Hannaford Pharmacy-Martin’s Point Healthcare PGY1 Resident, Jacob Turmel, Husson Class of 2016, and Minh Pham, UNE Class of 2016.

The pharmacist and student pharmacist contingent who attended the joint House/Senate hearing at the Cross State Office Building in Augusta (2/24) on LD 141 “An Act to Amend the Definition of ‘Health Care Practitioner’ in the Maine Health Security Act to Include Pharmacists” which was introduced by Representative Paul Chace. 

 
Many individuals testified in favor of the bill including Dr. Ken McCall from UNE, Dr. Dan Robinson from HUSOP and Whitney Jandreau (HUSOP P4 and the only student pharmacist speaking). There was no testimony against the proposed act.Students and Pharmacists at LD141 Hearing with Representative Chace