BILL ANALYSIS �
AB 670
Page 1
Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 670 (Atkins) - As Amended: April 30, 2013
Policy Committee: Business,
Professions and Consumer Protection Vote: 8-2
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill prohibits a pharmacist or pharmacy employer from
receiving compensation for recommending or replacing a patient's
originally prescribed drug with a therapeutic alternative,
unless the recommendation or replacement is part of a
comprehensive medication review (CMR), which includes a patient
consultation.
FISCAL EFFECT
1)Unknown but potentially major costs, greater than $1 million,
to state health insurance purchasers, including the California
Public Employees' Retirement System, for increased
prescription drug costs to the extent some programs intended
to control prescription costs may need to be revised or
eliminated.
2)Minor costs to the Board of Pharmacy.
COMMENTS
1)Rationale . This bill seeks to assure patients changes made by
a pharmacy to their prescription medication are based on
medical necessity and professional judgment rather than any
kind of financial incentive. This bill requires a pharmacist
participating in an incentive program to promote therapeutic
drug replacements be paid only if the pharmacist conducts a
CMR, which is an extensive, documented review of all of the
patient's prescription and over-the-counter medication, with
an emphasis on patient education and self-management. This
bill exempts payments for general consultative services that
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are not tied to payments for recommending or replacing drugs.
Opponents include health plans, hospitals, pharmacists, and
retailers. Opponents contend current law already contains
patient safeguards that allow a physician to prohibit drug
replacements and subject a pharmacist to an unprofessional
conduct for failing to use the best professional judgment in
recommending a drug replacement. This bill is sponsored by the
California Medical Association.
2)Incentive programs . The federal Medicare program and the
Affordable Care Act are driving innovations to reduce costs
and promote better care and outcomes across the healthcare
spectrum. Private health plans are also devising their own
systems to optimize cost savings and health, which may include
incentive programs. At issue is determining when an incentive
has unintended, unacceptable consequences.
Medicare targets individuals with certain chronic conditions
for voluntary Medication Therapy Management (MTM). MTM
programs work to identify potential medication-related
concerns and suggest improvements. Some programs have tied
pharmacist incentive payments to suggested medication changes
as well.
3)Comprehensive medication review . MTM programs are required to
provide an annual CMR with written summaries in federally
standardized format. A CMR is a systematic process of
collecting patient-specific information on an annual basis,
assessing medication therapies to identify medication-related
problems, developing a prioritized list of medication-related
problems, and creating a plan to resolve them with the
patient, caregiver and/or prescriber. It is an interactive
person-to-person consultation conducted between the patient
and/or caregiver and the pharmacist, and is designed to
improve patients' knowledge of their prescription,
over-the-counter medications, herbal therapies and dietary
supplements. CMR consultations also identify and address
problems or concerns that patients may have, and empower
patients to self-manage their medications and their health
conditions. Pharmacists frequently search for cost-saving
solutions during these reviews.
4)Generic v. therapeutic drug substitutions . A generic drug is
approved by the Food and Drug Administration (FDA) as
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identical to a brand-name drug in active chemical ingredients,
dosage form, safety, strength, route of administration,
quality, performance characteristics, and intended use. A
generic drug is considered a therapeutically equivalent
substitution, and is typically used to reduce costs. A
pharmacist may substitute a generic drug for a brand name drug
unless the prescriber objects.
A therapeutic substitution is a different product than the
drug originally prescribed and is considered a therapeutic
alternative, meaning the drug contains a different active
chemical ingredient but is in the same pharmacological or
therapeutic class and has a similar therapeutic effect. A
therapeutic substitution can occur between branded products,
between generic products, or between branded and generic
products. A pharmacist may recommend a therapeutic
substitution to lower costs, to prevent adverse effects, or to
achieve more effective treatment. A pharmacist may not
suggest a therapeutic substitution if the prescriber indicates
verbally or in writing not to substitute. Prescription forms
often contain a "do not substitute" or "dispense as written"
checkbox prescriber use.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081