Week 7 Legislative Update

With the first funnel deadline behind us and the second funnel still a few weeks away, both chambers shifted their focus this week to floor debate. A number of noncontroversial bills were taken up and passed by both chambers. IMS spent this week working with legislators and staff to prepare for floor debate on several issues of importance to the medical community including:

 

Opioid Abuse

Last week, we told you about committee passage of the House opioid omnibus legislation. Among its many provisions intended to help address Iowa’s opioid abuse problem, is a mandate that all prescribers register for the Prescription Monitoring Program (PMP) and utilize the PMP prior to issuing a prescription for any controlled substance. As we have noted, IMS continues to oppose a PMP use mandate, however, in light of the significant legislative support for moving forward with this mandate, we have shifted our focus to narrowing the breadth of the mandate and minimizing the impact on Iowa practices.

This week, IMS succeeded in in these efforts. In an amendment that was filed on Thursday, the bill’s floor manager is narrowing the PMP use mandate to apply only in instances where an opioid is being prescribed. In addition, the amendment allows for a prescriber’s designated agents to access the PMP on his or her behalf to satisfy the use mandate, rather than requiring the prescriber to do so directly. Since 2012, the Iowa Board of Pharmacy (IBP) has allowed prescribers to designate agents, typically a nurse or medical technician, to access the PMP on their behalf. Last year, the IBP increased the number of agents an individual prescriber may designate for a maximum of six designated agents per prescriber. This amendment, which is expected to be adopted when HF 2299 is debated by the full House on Monday, will significantly decrease the administrative burden of the PMP use mandate, while still achieving legislators’ intention of ensuring prescribers have a fuller picture of a patient’s prescription history prior to issuing an opioid prescription.

 

Behavioral Health

Work continues behind the scenes as legislators work to reconcile the difference between the two behavioral health bills we told you about last week. A critical component included in HF 2456, which is not currently in SF 2351, are the provisions to streamline the involuntary commitment process to expedite patients in need of behavioral health services moving to the appropriate level of care. IMS sought changes this year to allow for expedited triggering of involuntary commitments and to allow for physicians to end an involuntary hold early if they determine the patient has become stable more quickly than anticipated and can be safely treated at a lower level of care.

The House bill includes provisions to allow for early discharge from an involuntary hold and establishes a formal interim workgroup to develop recommendations for streamlining the involuntary commitment intake process to allow for additional review of civil liberty concerns that were raised by some in discussions of proposal put forward by IMS. This week, the Senate floor manager of the bill indicated that he would move forward with incorporating the House provisions on this issue into the Senate bill when it comes to the floor for debate in the next few weeks. Additional differences between the two bills must still be worked out. The House is expected to take up HF 2456 on Tuesday.

 

Pharmacist Statewide Protocols

A few weeks ago, we told you about the legislation IMS negotiated with the Iowa Pharmacy Association (IPA) to establish a legal framework for statewide protocols to allow pharmacists to dispense or administer a series of products without an individualized prescription or a formal agreement with a local prescriber. As we reported, IMS and IPA failed to reach an agreement on all aspects of the bill, with the issue of pharmacists administering HPV, Tdap, and meningococcal vaccines to adolescent patients between ages 13 and 18 being the final sticking point. In response to pressure from legislators and IPA, the IMS Committee on Legislation agreed to a compromise to allow pharmacists to administer the final one to two doses of HPV vaccine for these adolescent patients, which is the language currently included in the bill. At the subcommittee for the bill, IPA brought an amendment to strip out this compromise and replace it with full adolescent vaccination authority for patients over age 13.

Over the past few weeks, IPA has been pushing legislators to move forward with its amendment. IMS, in conjunction with the other members of Team Doctor and representatives from Blank Children’s Hospital, have been urging Senators to maintain the compromise that was agreed to prior to the bill moving out of committee. This week, the floor manager for SF 2322 informed IMS that he is moving forward with the IPA amendment. IMS, along with the other members of Team Doctor have moved to a position of opposition on the bill in anticipation of this amendment and are working to halt the bill’s progression.

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