House Bills 5475-5476 would amend the Health Care False Claim Act (PA 323 of 1984) and the Medicaid False Claim Act (PA 72 of 1977).

The amendments to the Health Care False Claim Act and the Medicaid False Claim Act will achieve the following:

• Create and define audit criteria
• Audits and sample size will be representative of the true book of business for pharmacies
• Pharmacies shall be provided written notice at least two weeks before conducting the initial audit and be provided a mechanism to reschedule if necessary
• Any audit that involves clinical or professional judgment must be conducted by or in consultation with a pharmacist licensed in the state of Michigan
• Any clerical or record-keeping error shall not on its face constitute fraud without proof of intent to commit fraud
• A finding of overpayment or underpayment must be based on the actual overpayment or underpayment and may not be a projection based on the number of patients served having similar diagnosis or on the number of similar orders or refills for similar drugs
• Recoupment or payment adjustments of claims must be based on the actual overpayment or underpayment unless the pharmacy agrees to a projection as part of a settlement
• A finding of an underpayment shall be reimbursed with interest for the time period between detection and payment
• Create and define an appeal process
• Clarify what a valid medication order is, including those in health facilities

Click here for a printable issue sheet on the Department of Community Health.

KEY STATEMENT
Pharmacists must be actively involved in solutions related to Department of Community Health issues for patients in Michigan to have the best care possible.

BACKGROUND
Michigan pharmacy professionals have played an integral role in assisting the Department of Community Health in key issues to improve patient care. Appropriate reimbursement of the dispensing fee, prescription drug product
and clinical pharmacy services helps pharmacies continue to provide quality care to beneficiaries. The Medicaid dispensing fee has remained unchanged this past year, and pharmacies continue to take on additional costs to lead the way with electronic prescriptions. Pharmacists continue to expand their key role in providing immunizations and increasing immunization rates, and for the first time this past year, Medicaid is now reimbursing for this service. Medicaid has considered introducing programs to help patients better manage their medications and lower health care costs through direct consultation with a pharmacist, but those medication therapy management programs have not been initiated by the Department.

WHY IS PHARMACIST INVOLVEMENT IN DECISIONS ABOUT
DEPARTMENT OF COMMUNITY HEALTH PROGRAMS IMPORTANT?

• Costs continue to rise to provide quality pharmacy care to patients, and Michigan’s Medicaid fee-for-service dispensing fee is one of the lowest in the nation. In order to continue to provide access to patients, the dispensing fee MUST be maintained.
• Pharmacists must be actively involved in the e-prescription process and policy, and the cost of transmitting e-prescriptions must be shared between providers. Pharmacists are in a unique position to ensure the quality and efficiency of electronic prescribing. Other providers are reimbursed for e-prescriptions; however, pharmacists are not.
• No one is better at helping patients get the most out of their medications than pharmacists, the medication experts. By implementing Medicaid medication therapy management programs, overall costs will decrease, as evidenced by studies in Michigan and across the nation.
• In order to increase immunization rates in Michigan, pharmacists must continue to be involved and reimbursed appropriately, as the most accessible health care providers.
• An integral piece of a patient’s care is the medications they take to get well, maintain their health and reduce total health care costs. As such, pharmacists must be a part of patient-centered medical home and accountable care organizations.
• As a leader in health care technology, pharmacists provide important perspective with health information exchanges (HIE) and provide important data to keep patient’s health records accurate for all other providers. However, this information is currently only being transmitted one way by the pharmacist. In order to safeguard patients, information must flow back and forth.
• In addition, pharmacists would be helpful in assisting with such issues as mental health parity, medical marijuana, emergency preparedness and others.

BOTTOM LINE
A patient’s health care is not complete without a pharmacist’s involvement. Any discussion, program and solution related to a patient’s health through the Department of Community Health needs pharmacy’s perspective, expertise and active participation to be successful.

Click here for a printable issue sheet on emergency preparedness.

KEY STATEMENT
Pharmacy professionals play an important role in responding to emergency events, such as a natural disaster or infectious disease outbreak. They are called upon to urgently dispense medications from the Strategic National Stockpile (SNS) to protect the public and save lives.

BACKGROUND
As disaster events have unfolded, such as the Sept. 11 attacks, the 2010 Haiti earthquake, the 2011 tsunami and earthquake in Japan and Hurricane Irene, pharmacists’ role in preparing for emergency response has become increasingly important. Pharmacists collaborate with a diversity of health care personnel to assure the safe use of medications in patients. Their expertise and knowledge of medications during a public health emergency have proven to be a valuable asset to successful response efforts. Michigan Pharmacists Association (MPA), as well as the state of Michigan, works to provide guidance for pharmacists interested in exploring opportunities in emergency preparedness through educational resources, training, participation in drills and other preparatory programs. MPA’s Emergency Preparedness Coordinator consults with other health personnel in the state to plan pharmacy response efforts, as well as promotes pharmacist involvement in activities that allow them to become more knowledgeable, competent and better prepared to play a contributory role when called upon in an emergency situation.

WHY ARE PHARMACISTS IMPORTANT TO EMERGENCY RESPONSE EFFORTS?

• Pharmacists are highly-visible members of the health care community, and involvement in emergency preparedness begins at a local, community level. Unlike many other emergencies, pandemics are not localized to a single region of the country given the mobility of individuals, carriers of the virus and transmission through various means. Because of this, careful and considerate local and community planning is essential to a successful response. Pharmacies are an important part of any local response and pharmacy professionals are adequately equipped to assist the public during response efforts.
• Michigan pharmacists have been actively engaged in community and statewide emergency preparedness efforts, including the first deployment of Michigan’s mobile field hospital in 2011, to prepare for the potential need for their assistance in disaster response.
• Pharmacists also protect their patients and staff by encouraging them to have a personal and family emergency plan in place, including an organized record of medication information, supplies and communication mechanisms.
• As their role in providing vaccines continues to expand, pharmacists can help prepare for the potential of pandemic influenza. During the H1N1 outbreak in 2009, pharmacists were instrumental in providing patients with pertinent information to make informed choices about their immunizations.

BOTTOM LINE
There is a growing need for pharmacists to play a pivotal role in emergency response efforts. As the most accessible health care provider, pharmacists play an especially vital role when a disaster disrupts a community’s health care system. Through provision of training opportunities and enhanced knowledge of emergency response, pharmacists will continue to adequately prepare for potential emergency events.

March 23, President Barack Obama signed into law the Patient Protection and Affordable Care Act, two days after the House passed the Senate reform bill by a vote of 219-212. This historic piece of legislation will provide the most sweeping changes to the U.S. health care system since legislation in 1965 created the Medicare program. This bill, which is expected to cost around $940 billion, will provide new coverage for more than 32 million individuals who do not currently have health insurance.

Some key pharmacy provisions included in the health care reform legislation are as follows:

• Improved definition of average manufacturers price (AMP) and direction to reimburse generic medications at a rate of not less than 175 percent of the weighted AMP
• Closure in the Medicare Part D coverage gap or “donut hole” over a period of 10 years through a rebate of $250 per beneficiary for 2010, then moving to a 50 percent discount on negotiated pricing for brand-name medications with the pharmaceutical manufacturers
• Increased funding of $250 million to fight Medicaid fraud, waste and abuse over the next 10 years
• Exemption for most pharmacies from durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) accreditation requirements if their Medicare durable medical equipment billings are 5 percent or less of total prescription sales. This legislation will also delay the date of pharmacy accreditation requirements for providers that do not qualify for the exemption until January 2011.
• New dispensing requirements for long-term care pharmacies in an effort to reduce waste from unused medications

State of Michigan Health Care Reform Web site

Obama Health Care Reform Web site

Sen. Debbie Stabenow's Health Care Reform Online Resource Center
Sen. Stabenow is a member of the Senate Finance Committee, one of the two Committees writing health care reform legislation.

Summary of Health Care Reform Legislation

Health Care Reform Timeline

New Resource Aims to Educate Consumers on Health Care Reform
The Health Care and You Coalition recently launched a new Web site, HealthCareAndYou.org, designed to provide the public with a comprehensive online resource and easy-to-understand information on health care reform. This online guide includes tailored information for consumers, including what provisions of the law are in effect now and when future provisions go into effect.

Click here for a printable issue sheet on immunizations.

KEY STATEMENT
Along with managing medication therapy and educating patients on healthy lifestyle practices, certified pharmacists can also administer critical immunizations, ensuring that any treatment received will not interfere with other therapies.

BACKGROUND
Pharmacists continue to play a critical role in improving public health through providing vaccines, and opportunities continue to grow for pharmacists who are certified immunizers. As the most accessible health care providers, pharmacists can help ensure that patients are up-to-date on all their immunizations, as well as answer questions and provide necessary protection from harmful diseases. The majority of American adults are inadequately vaccinated, leading to an average of 90,000 deaths each year from vaccine-preventable infections. And although vaccine rates for U.S. children at the time they enter school exceed 95 percent, nearly 25 percent do not complete their primary series by the age of two years. This long-standing failure to adequately immunize the U.S. population helped prompt the inclusion of immunization in Healthy People 2020, a 10-year initiative for improving the health of all Americans. Pharmacists contribute to this effort by administering vaccines where their scope of practice allows and promoting immunization through public health.

WHY ARE PHARMACISTS A VALUABLE SOURCE OF VACCINE DELIVERY?

• The potential role of pharmacists in addressing the problem of low immunization rates has been recognized by both state and federal government. In 1999, only 22 states allowed pharmacists to administer influenza vaccinations to adults. In 2007, the number of states allowing this increased to 46, and in June 2009, all 50 states allowed pharmacists to administer influenza vaccinations (under prescribing protocols or prescription) to adults. In addition, the American Pharmacists Association (APhA) established the Pharmacy-Based Immunization Delivery Program in 1996, which the Centers for Disease Control and Prevention (CDC) endorsed. Later, the CDC granted APhA a liaison position on the Advisory Committee on Immunization Practices.
• When it comes to immunizations, pharmacists have proven to be a critical link to increasing access in a cost effective manner. Receiving vaccines at a pharmacy increases convenience for patients, with more accessible hours, often without an appointment or a long line in the waiting room.
• Through providing vaccines, pharmacists continue to show a significant, positive impact on the health and well being of the public. A study published in 2004 in the journal Vaccine found that pharmacists increased immunization uptake 5 to 7 percent across all age groups for states allowing pharmacists to provide immunizations.

BOTTOM LINE
Pharmacists have ample opportunities to advance public health through providing immunizations and advocating for their importance. As their role in vaccination delivery continues to evolve, pharmacy professionals will become more encompassing members of the health care team. This will also assist pharmacies in building loyalty among the general public and diversifying revenue sources.

House Bill 5547 would amend the Michigan Public Health Code and would require the pharmacist in charge to provide coverage to residents of an institution when the pharmacist is not on site, and regulate use of emergency drugs and medication drug kits.

Currently:

• a caregiver or health professional in medical institutions administers medications authorized by the prescriber on the resident’s “chart order.”
• certain entities are not recognizing this “chart order” as equivalent to a valid prescription order.
• the pharmacies that provide medications to these medical institutions comply in the same manner as pharmacies located on site in other medical institutions (i.e., health-systems).
• there are often situations in these facilities where residents require immediate care that may easily be provided by contingency or emergency drug kits, particularly for residents who cannot wait until the next day to receive their medications.

This proposed legislation would amend the Michigan Public Health Code to:

• clarify the definition of an institutional pharmacy.
• recognize the “chart order” or the medication order as a valid prescription.
• define the use of contingency or “emergency drugs” as those which are required to meet the immediate therapeutic need of a resident of a medical institution.
• recognize the medical institution nurse as the agent of the prescriber.
• ensure accurate and efficient administration of medications to residents and prevent diversion of controlled substances stored and administered in these facilities.

Click here for a printable issue sheet on medication safety.

KEY STATEMENT
Medicines play an important role in treating certain conditions and diseases, but they must be taken with care. Pharmacists are critical to ensuring that patients are safely and effectively taking their medications, avoiding harmful interactions and educating the public on the importance of adhering to medication therapies. Unused portions of these medicines, including those that are expired or unwanted, must also be disposed of properly to avoid harm, to both patients and the environment.

BACKGROUND
Pharmacists are the medication experts and patient advocates on the health care team. Their extensive knowledge of medications and treatments are critical to patients in making sure medications are used safely, and that patients are informed and ready to comply with their medication regimen. Pharmacists assure medication distribution systems are safe, constantly working to prevent medication errors and costly medication problems, as well as increase patients’ quality of life. By participating in and organizing medication disposal events and providing drop-off services, pharmacists and pharmacy organizations also help protect the environment and curb potential medication abuse.

HOW DO PHARMACISTS IMPACT MEDICATION SAFETY?

• In 2011, several studies showed that medication nonadherence could cost the United States more than $250 billion per year. Missing doses of prescribed medications could lead to costly hospital visits, and not taking medications properly often yields the same results. Researchers also found that more than half of people who believe they take their medications properly are not. As the medication experts, pharmacists are available to answer patient questions regarding their medications. Pharmacists also offer medication therapy management (MTM) services, where patients can sit down face-to-face with their pharmacist and get help with managing their medications.
• During MTM sessions or a patient’s visit to their pharmacy, pharmacists can explain the importance of taking medications when directed, provide reminders, look for potentially harmful interactions, and create a chart or wallet card listing all medications so the person has it in an emergency. Pharmacists are always looking for new and innovative ways to encourage the safe use of medications.
• More than seven million Americans currently abuse prescription medications, and each day, nearly 2,500 teens use these medications to get high for the first time, according to the Partnership for a Drug Free America. Studies show that a majority of abused prescriptions are obtained from family and friends, including out of home medicine cabinets. Medication disposal events and pharmacy drop-off locations help increase awareness of safe disposal practices, as well as address a vital public safety and health concern.

BOTTOM LINE
The general public often doesn’t adhere to medication therapies because they forget to refill precriptions, forget to take them, feel they don’t need them or find them too expensive. Pharmacists are in a unique position to explain the importance of taking medications as prescribed and look for possible adverse effects to avoid costly hospital visits. They play a vital role in medication safety by offering safe disposal options as well, preventing family and friends from having access to medications they could potentially abuse.

Click here for a printable issue sheet on medication therapy management.

KEY STATEMENT
Pharmacists strengthen patient health and decrease costs by providing medication therapy management (MTM) services.

BACKGROUND
MTM is directly addressed in the new health care reform package, and the law now recognizes the key role that pharmacists play in one-on-one consultations to optimize patient medication use and help them best manage their therapies to improve chronic diseases. Medicare does reimburse for MTM services, but only a fraction of seniors qualify or are given an opportunity to take advantage of this critical protection. Medicaid has considered introduce programs to help patients better manage their medications and lower health care costs through direct consultation with a pharmacist, but those MTM programs have not been initiated through the Department. Some health plans and physician groups have participated in pharmacist-led pilot projects in Michigan to launch MTM services to better serve patients in the patient-centered medical home, and results show key health improvements and reduction of costs.

WHAT IS MEDICATION THERAPY MANAGEMENT?

• Through MTM, pharmacists help patients effectively manage all of their medications and treatments during review, counseling, collaboration with other health professionals and follow up.
• MTM keeps patients safe by ensuring that all of their medications are working properly together and are not dangerously interacting with each other. It also puts patients in the driver’s seat of their health by helping them be proactive in setting therapy goals and pharmacists following up to be sure that patients get the most from their medications.
• MTM is proven to help patients reduce their health care costs, which is so critical in this economy. Patients who are receiving medication therapy management services from their pharmacists are often spending less on medications because a pharmacist is continually making sure their therapy is still effective. Also, patients are more likely to remain committed to their medication regimen, which improves their health and reduces their overall costs by preventing future issues.

MTM WORKS. HERE’S HOW:

• In the “Asheville Project”, city employees participated in pharmacist-led MTM for blood pressure and cholesterol. After MTM, patients achieved goals more than 25-30 percent than the baseline, and ER visits due to cardiovascular events were cut in half. This resulted in a decrease of cardiovascular-related costs of more than 11
  percent of the city’s total health care costs.
• In a 14-month program at Chrysler’s Sterling Heights Assembly plant, a pharmacist met with employees with diabetes. The pharmacist worked with each patient on managing their diabetes and addressing the concerns of workers regarding their disease. Results showed the employees health improved and their “sick time” off work decreased.
• In another study, diabetic patients were referred by their physicians to pharmacists for drug therapy management. Pharmacist intervention helped patients manage their diabetes and achieve better glucose control. These patients also had less ER visits after one-on-one interactions with their pharmacists, saving each patient an average of $1,798 per year, or $197,780 total among the study participants.
• A group of community pharmacies partnered with asthma patients in an ongoing cycle of assessment, goal setting, monitoring and evaluation of their conditions over a six-month period. At the end of the study, patients who had received pharmacist care were nearly three time more likely to no longer have severe symptoms vs. the control group.

BOTTOM LINE
Pharmacist-provided MTM services must become the standard for patients who have multiple conditions and drug therapies. Patients will receive better comprehensive care, get the most from their medicines and improve their well-being, and health care costs will decrease as a result. Reimbursement should
adequately address the value of this critical, cost-saving service.

Click here for a printable issue sheet on outsourcing prescriptions.

KEY STATEMENT
Outsourcing prescriptions is bad business for Michigan.

BACKGROUND
Though the state of Michigan had made many strides to reverse mandatory mail order in last year’s RFP for new pharmacy benefits managers for the state’s workers, retirees and educators, patients are still being economically coerced into outsourcing their prescriptions.

WHY IS OUTSOURCING PRESCRIPTIONS DAMAGING TO MICHIGAN?

• Outsourcing prescriptions is driving Michigan businesses to close and hurting families.
  • Hundreds of pharmacies across the state have closed in the last several years, in part due to patients they had provided care being forced to ship their prescriptions out of state.
  • More than 3,000 pharmacy jobs have been lost as a result, putting those employees in a lurch to provide for their families. Many pharmacists graduating from Michigan’s three colleges of pharmacy are forced to move to other states to find work.
  • The combined dollars lost because of tax revenue that is sent to out-of-state mail order facilities totals in the hundreds of millions, which could have been used to grow Michigan’s economy.
    
    
• Outsourcing prescriptions decreases patients’ access to care and puts their health in danger.
  • Mail order eliminates a patient’s opportunity to have face time with a pharmacist, who is required by law to be available and help patients understand how to use their medications.
  • Mail order often results in patient’s receiving medications from multiple different sources, without a central coordination of care by a pharmacist, who can make sure that all of the medications work safely together.
  • Outsourcing prescriptions puts a patient in greater peril for potential drug interactions or not taking their medicine safely, which causes health care costs to skyrocket when patients end up in the emergency room because of medication errors, adverse events or lost prescriptions.
    
    
• Outsourced prescriptions are piling up in landfills and being found in Michigan’s waterways.
  • Many times, mail order prescriptions deliver a larger quantity during a given period than necessary and are refilled automatically regardless of need. Because patients have no opportunity for face-to-face interactions with their pharmacist or personal follow-up to make sure they are continuing to properly take their medications, or the physician changes the medication, mail order prescriptions produce a volume of costly, unused medication waste.
  • Medication disposal events around the state of Michigan continue yield a disproportionately high return of outsourced prescriptions. This waste drives up the base prescription costs by requiring patients to purchase more than they need and then throw away the rest.
  • With the growing number of studies showing traces of medications in the water supply and ground soil, mail order waste helps propel this growing issue of concern.

BOTTOM LINE
Outsourcing prescriptions has shipped hundreds of millions of dollars and thousands of jobs out of the state, has put patient health in jeopardy and has negatively impacted the environment. Mandating this potentially dangerous
practice can no longer be tolerated by state government.

Click here for a printable issue sheet on pharmacists and your health care.

KEY STATEMENT
Pharmacists are the medication experts, and their professional services ensure that patients receive the best health care outcomes and obtain the best results from their medications. As the state professional pharmacy organization, Michigan Pharmacists Association (MPA) is committed to providing its members with support, advocacy and resources that ultimately improve patient care, safety, health, and the practice of pharmacy.

BACKGROUND
The average adult fills about a dozen prescriptions and refills every year, and after age 65, they fill more than 30 prescriptions annually. With such a high volume of prescriptions being filled, it’s vital for patients to understand their medications, including how to take them, what to do if they experience side effects, how long to take them and whether or not it’s safe to combine them with other medications or dietary supplements. As the most accessible health care providers, pharmacists are in nearly every community (rural, urban and suburban), including hospitals, long-term care settings and other medical institutions. They’re available to answer these questions and ensure that patients are getting the most from their medications.

PHARMACISTS SAVE LIVES AND HEALTH CARE DOLLARS. HERE'S HOW:

• Pharmacists identify medication duplications and interactions, thus preventing unnecessary and costly emergency room visits or hospitalizations. As trained experts in medication safety and medication use, pharmacists are committed to ensuring that patients’ experiences with prescription and over-the-counter medications are safe and effective. They are also involved throughout the course of patients’ treatments, both at home and in health-systems, long-term care facilities and other institutions.
• Pharmacists are able to assist individuals in obtaining cost effective medications every day. They can review medication therapies and determine if there are any low-cost generic alternatives. Pharmacy professionals are also knowledgeable about prescription assistance programs, and pharmacies may partner with their local health department to offer specific services free or at a lower cost for those who are uninsured or underinsured.
• Pharmacists are ready to help find solutions for patients to continue their therapies. They can also act as an advocate with your insurance company to make sure your medications are covered.
• Pharmacists are in the unique position to provide a wide variety of patient care services, from one-onone counseling with medication therapy management, to administering vaccines. They can also provide general health screenings for blood pressure, cholesterol levels, diabetes and other conditions, helping patients to be proactive with their health. The role of the pharmacist continues to expand, perfectly positioning pharmacy professionals to help address national health care issues and further increase their accessibility.

BOTTOM LINE
As the medication experts on the health care team, pharmacy professionals are committed to reducing health care costs, improving lives and increasing adherence. The public has ranked pharmacists in the top three each of the past eight years in Gallup’s survey of honesty and integrity across professions. They rely on them for a wide array of patient care services and to guide them through the medication use process.

Click here for a printable issue sheet on pharmacy benefit managers.

KEY STATEMENT
Pharmacy benefit managers (PBMs) must be regulated to stop abusive practices. In doing so, government entities and employers can realize significant cost savings.

BACKGROUND
Legislators, government entities and employers are beginning
to realize the impact of the abusive practices of PBMs. As a result, several pieces of legislation have been introduced in the last year to regulate this industry and require transparency in contracts to hold PBMs accountable. Last year, HB 5772 was introduced in the Michigan legislature to regulate PBMs, as well as protect
patients. Congress also attempted to address PBM regulation, with the PBM Audit Reform and Transparency Act of 2010. Both bills languished in Committee. Also this past year, the State of Michigan overhauled its contract for prescription services for state employees and retirees and Michigan Public Schools Employee Retirement
System, with recommendations from Michigan Pharmacists Association. However, many complaints have already been brought to MPA in regards to the new PBMs.

WHY IS PBM TRANSPARENCY AND REGULATION IMPORTANT?

• PBMs coordinate prescription drug benefits and networks. When it comes to contracts for prescription drug benefits, including costs for generics, it is the PBM, not the pharmacy, which determines the price. Within a PBM contract with an employer, prices are set for prescription drug benefits and administrative fees. However, PBMs also separately offer a non-negotiated contract to pharmacies for the reimbursement it will pay for distribution of those medications. Often, the price discrepancy between these two contracts is wide, causing employers to pay much higher prices than necessary.
• If PBM contracts were negotiated on a pass through model, full disclosure would be required so the employer simply reimburses the PBM for the amount paid to the pharmacy provider and the negotiated administrative fee. Pass through pricing means that the PBM must pass through to the employers all financial benefits (including, but not limited to, 100 percent pass through of all rebates, associated fees and revenue streams) obtained from all pharmaceutical manufacturers, wholesalers and other sources.
  
• PBMs should be prohibited from paying their own mail order pharmacy more than another pharmacy for the prescription drug. That negative preferential business model deprives patients of access and hurts pharmacy small businesses.
• PBMs currently can dictate therapy choices, instead of allowing a physician and pharmacist to treat a patient. Prescriptions should not be allowed to be changed without a patient’s consent, in consultation with a medical professional, NOT an insurance middleman.

PBM PASS THROUGH CONTRACTS RESULT IN
SIGNIFICANT SAVINGS. HERE’S HOW:

• Implementation of a pass through contract saved the Union DC-37 in New York millions of dollars. The union, with around 30,000 members, had a “traditional” margin-based pricing arrangement with a PBM. The contract included requiring their members to use a mail order prescription system, which resulted in two times the co-pay and mandatory generics with copay penalties. The union was experiencing a trend of a 15-20 percent annual increase in prescription drug costs. In 2006, the union switched to a pass through and auditable PBM contract, removed mandatory mail order and implemented a 90-day prescription supply retail agreement. Actual savings were estimated to be between $74-100 million the first year.
• Pass through contracts have also been demonstrated to be successful at the University of Michigan. In 2006, studies revealed the discrepancy in pricing between the costs paid to its PBM as an employer and reimbursed to them as a provider of health care services. As a result, the University of Michigan renegotiated the PBM contract, with its prescription drug program that provides care for more than 80,000 people with an annual expenditure of $70 million. The university realized substantial cost savings of $6.5 million from improved drug pricing and the creation of several unique drug therapy projects, due to increased flexibility, drug plan decision-making authority and 100 percent pass through of drug rebates.

BOTTOM LINE
Regulating PBMs, requiring transparency and renegotiating pass through contracts is simply a smarter way to do business while continuing to provide quality health care benefits to employees.

Click here for a printable issue sheet on technician certification.

KEY STATEMENT
Licensing pharmacy technicians keeps patients safe, ensures better care and helps decrease drug diversion.

BACKGROUND
Michigan is one of only seven states in the nation that does not have any baseline standard for pharmacy technicians. Pharmacy technicians play an integral role in the medication dispensing process, and currently in Michigan, they are not even required to have a high school diploma or receive any ongoing training. This is certainly disappointing, considering that Michigan is one of the first states to provide pharmacy technician training. In 2010, legislation was introduced to amend the Michigan Public Health Code by formally recognizing pharmacy technicians and requiring licensure and certification. Unfortunately, the bill languished in the Health Policy Committee.

WHY IS PHARMACY TECHNICIAN CERTIFICATION IMPORTANT?

• Currently there are no requirements in the state of Michigan to validate the minimal standards, knowledge or understanding of the individuals currently assisting pharmacists. Licensure and certification of pharmacy technicians will ensure appropriate and consistent care and safety of patients served by pharmacies.
• Pharmacy technicians play a sensitive and critical role in preparing medication orders and prescriptions; however, even if certification is present, law still requires the accountability of the supervising pharmacist, who is legally responsible by virtue of state licensure for the care and safety of patients served by the pharmacy.
  
• With the ever changing nature of medications and new advances in pharmacy, continuing education is necessary for pharmacy technicians in order to keep patients safe. Certification would require ongoing continuing education.
• Certification with a nationally approved, psychometrically evaluated exam (the Pharmacy Technician Certification Board exam) ensures validity and measurable statistics for pharmacy technicians consistent with nationally approved and recognized exams given to pharmacists. The examination is supported by the National Association of Boards of Pharmacy, the same entity responsible for providing a national examination that provides assurance pharmacists applying to their respective board for licensure have the knowledge and skills necessary to safely practice entry-level pharmacy.
• Pharmacy technicians have access to controlled substances. The Michigan Department of Community Health (MDCH) has reported that most cases of diversion that occurs within a pharmacy can be attributed to unlicensed individuals. By licensing pharmacy technicians, it provides a more stringent disciplinary approach to inappropriate behavior, holding pharmacy technicians accountable.

BOTTOM LINE
Support pharmacy technician licensing and certification in order to safeguard the health of your constituents. Integral members of the pharmacy team must have minimum standards of education to ensure the best care possible for patients depending on medications to get well and maintain their health.