Week 5 Legislative Update

Both chambers spent considerable time this week moving bills through subcommittee and committee ahead of next week’s first funnel deadline. After next Friday, the vast majority of policy bills will become ineligible for consideration this session unless they have made it out of a committee in their chamber of origin. Several issues of interest to the medical community were discussed this week including:

Scope of Practice

Optometrist Injections & Surgical Procedures

On Tuesday, the Senate held a lengthy subcommittee to consider SSB 3079, which repeals statutory restrictions to allow an optometrist to perform injections and certain surgical procedures, so long as they do not penetrate the globe of the eye. Almost a dozen ophthalmologists and ophthalmology residents, and nearly as many optometrists, traveled to the capitol to participate in the discussion. The ophthalmologists helped educate legislators on the training differences between the professions, the specific procedures that would be allowed by this legislation, and the safety concerns the medical community has with this proposal. The optometrists walked through their new training programs, which include 16 hours of viewing surgical procedures, but not actual surgical experience, and argued that the legislation is necessary to expand rural access. The members of the subcommittee expressed significant concerns with the proposal and declined to advance the legislation.

Pharmacist Statewide Protocols

This week saw the introduction of SSB 3146, a proposal initiated the Iowa Pharmacy Association (IPA) to establish a legal framework for a series of statewide protocols to allow pharmacists to dispense or administer a series of products without an individualize prescription or a formal agreement with a local prescriber. Over the past several weeks, IMS has been working behind the scenes with IPA and key legislators to roll back several concerning provisions included in their original proposal. The bill introduced this week represents 95% agreement between IMS and IPA and would allow the following:

Patients Over 18 Years

  • Naloxone
  • Nicotine Replacement
  • CDC Recommended Immunizations and Vaccinations
  • Tdap Booster

Patients Over 11 Years

  • HPV Vaccine (Dose Completion Only)

Patients Over 6 Months

  • Flu Vaccine

Pharmacists would be required to check IRIS and the IHIN prior to administering or dispensing. Following administering or dispensing, they would be required to notify a patient’s primary care provider, and report into IRIS and the IHIN. Under current Iowa law, pharmacists are able to dispense or administer several of these products under other legal structures. This new legislation would streamline some of those processes, create new opportunities for patients to utilize their insurance to cover products, and close the current reporting loophole for flu vaccines administered by a pharmacist.

IPA continues to push for increased adolescent immunization authority. On Thursday, the Senate held a subcommittee to review SSB 3146. IPA brought an amendment to expand permissible immunizations to include all HPV vaccine doses, Tdap and meningococcal for patients over the age of 13. Under the original IPA proposal, these immunizations would have been allowed for patients over the age of 11. The IMS Committee on Legislation agreed to a compromise on HPV does completion, which is including in the current bill. The subcommittee opted to move the legislation forward without IPA’s amendment to ensure the bill survives next Friday’s funnel and indicated that they would have further discussion with both sides on IPA’s request.

Opioid Abuse

SSB 3008, the bill to legalize syringe exchange programs in Iowa that has been championed by students at Iowa’s two medical schools, unanimously passed a subcommittee in the Senate this week. IMS joined several member physicians and medical students offering testimony at the meeting, emphasizing the link between Iowa’s growing HIV and hepatitis infection rates, and the growth in injection opioid use in our state. The bill is scheduled to be taken up by the full Senate Judiciary Committee on Monday.

After weeks of working behind the scenes, this week House leadership unveiled their proposed policy solutions to addressing opioid abuse in the state. These measures, many of which are already moving in separate policy bills include the following:

  • Prescription Monitoring Program
    • Funding for the New PMP Scheduled to Go Live In April
    • Required Prescriber Registration with the PMP
    • Required Prescriber Utilization of the PMP Prior to Issuing Prescriptions for Controlled Substances
    • Pharmacist Dispensed Medication PMP Reporting Within 24 Hours
    • Proactive, Targeted Prescriber Notifications of At-Risk Patients
    • Annual Prescriber History Reporting
  • Required Electronic Prescribing of All Controlled Substances
  • Prohibition on Controlled Substance Prescriptions Over Six Months
  • Prohibition on Schedule II Prescription Refills
  • Required EMS PMP Reporting of Opioid Antagonist Administration
  • Required Pharmacist PMP Reporting of Opioid Antagonist Dispensing
  • Good Samaritan Protections for Overdose Situations
  • Expanded Telehealth Utilization
  • Implementation of the Complex Service Needs Workgroup Recommendations for Treating Substance Use Disorder

Several of these policy measures are recommendations put forward or supported by IMS, however, some are causes for concern as similar approaches have been pursued in other states and proven ineffective. IMS continues to emphasize physicians’ interest in playing an active role in combatting opioid abuse, which avoiding unnecessary and ineffective restrictions on their ability to provide care for their patients.

Telehealth Parity

On Wednesday, the House Commerce Committee voted to amend and advance IMS-supported HSB 572, which establishes telehealth coverage parity requirements for commercial health plans in Iowa. The amendment, which was pushed by the insurance industry, narrows the definition of telehealth services to include only real-time audio-video services. The legislation, while not as comprehensive as IMS has pushed for, still represents incremental progress in the move to establish coverage assurances for providers considering investments in staff and equipment to establish or expand the telehealth services they provide. The bill will now go before the full House for consideration.

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