Outside Section 195
Data Current as of: 8/9/2016
There shall be a special commission to study the practice by health insurers and pharmacy benefit managers of switching, for non-medical reasons, individuals with complex or chronic diseases from safe and effective prescription medications to other medications. The commission shall investigate and study several areas including, but not limited to, the following: (i) the frequency by which patients are switched from prescription medications to other medications for non-medical reasons and without the consent or notification of the patients' prescribing physicians; (ii) the frequency of a health provider prescribing an alternative drug in response to changes in health plan policies mid-year for non-medical reasons; (iii) evaluating the role of financial incentives to pharmacists and prescribers in prescription drug switching decisions, including but not limited to payment, fee, incentive or other contractual reward for choosing a drug alternative; (iv) determining the total cost to the commonwealth when individuals are switched from prescription drugs that have been safe and effective, including but not limited to increased use of services, emergency rooms visits, inpatient hospital stays and outpatient office visits; and (v) identifying the patient populations most impacted by and vulnerable to being switched from prescription drugs for non-medical reasons. The commission shall file a report on its findings and any accompanying recommendations to the joint committee on health care financing, the joint committee on financial services and the house and senate committees on ways and means on or before January 1, 2018.
The commission shall consist of the following members or their designees: the secretary of health and human services, who shall serve as chair; the executive director of the health policy commission; the executive director of the center for health information and analysis; 2 individuals with disabilities, one of whom shall be appointed by the speaker of the house and one of whom shall be appointed by the senate president; 2 individuals who are public policy or advocacy representatives for patient organizations with rare, complex or chronic diseases, one of whom shall be appointed by the speaker of the house and one of whom shall be appointed by the senate president and; 2 members appointed by the governor, 1 of whom shall be an individual who is an actively practicing physician with expertise in the use and prescribing of complex specialty medications including biologics in the treatment of chronic autoimmune diseases and 1 individual who is an actively practicing physician with expertise in treating conditions for which treatment disruptions are likely to result in excess morbidity, disability, or demand of health care resources such as hospitalization, emergency or urgent care visits. The commission may hold public meetings to solicit public input from interested parties in a manner and frequency to be determined by the chair.
I am vetoing this section because state agencies are already considering the issues to be addressed by this proposed commission. Recommendations to improve or address such prescribing practices can be made without the creation of a new 9-member commission.