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Review of Specialty Drug Dispensing and Patient Safety
Senate Amendment #935 to FY16 Budget

Problem:

Recent changes to certain health plan benefit structures require patients to obtain non-self-administered, injected or infused specialty medications through a specialty pharmacy, rather than obtaining them through the pharmacy at the hospital or clinic at which they are receiving treatment. Affected medications will no longer be covered in most cases unless the patient receives the medication at home and brings the drug to a hospital or clinic to be administered by a clinician (brown bagging); or the specialty pharmacy delivers the product directly to a hospital or clinic for use by a specific patient (white bagging). This practice raises significant patient and medication safety issues. 

Hospitals, community health center, physician offices and patients are all raising concerns about this proposed policy.

Solution:

Senator Keenan has introduced Senate Amendment 935 which will delay the required use of white or brown bagging until such time that the Division of Insurance and Department of Public Health can ensure that patient safety or care will not be negatively impacted.
Without Amendment # 935 this policy will go into effect July 1st and could have dangerous consequences to the health and safety of patient care. It should also be noted that this conflicts with current safety and regulatory standards.

Action Item

• Amendment #935 will be voted on this week (Wednesday or Thursday).

• Given the high number of amendments and multiple votes State Senators need to take this week they need hear (phone/email) from constituents asking them to support Amendment #935 which would review Specialty Drug Dispensing and Patient Safety.

Find your Massachusetts Senator and contact information here:
https://malegislature.gov/People/Search

Other key members who should be copied or contacted directly:

The Honorable Stanley C. Rosenberg
President of the Senate
State House, Room 332
Boston, MA 02133
Phone:617-722-1500
Fax:617-722-1072
Email:Stan.Rosenberg@masenate.gov

The Honorable Karen E. Spilka, Chair
Senate Ways and Means Chair
State House, Room 212
Boston, MA 02133
Phone:617-722-1640
Fax:617-722-1077
Email:Karen.Spilka@masenate.gov

Thank You
Senator John Keenan (D-Quincy) has showed tremendous leadership on this issue.  Thank you and appreciation comments should be directed to:
The Honorable John F. Keenan
State House, Room 413B
Boston, MA 02133
Phone:617-722-1494
Fax:617-722-1055
Email:John.Keenan@masenate.gov

Copy of Amendment Language
EHS 935
Review of Specialty Drug Dispensing and Patient Safety
Mr. Keenan moved that the bill be amended by inserting the following new section:-

SECTION __. The Secretary for Health and Human Services, in coordination with the Department of Public Health and the Division of Insurance, shall conduct a review of carrier practices which require certain categories of drugs, including those that are administered by injection or infusion, to be dispensed by a third-party specialty pharmacy directly to a patient or to a provider with the designation that such drugs be used for a specific patient and not for the general use of the provider. The secretary shall make recommendations to the General Court for the regulation or restriction of said practice as appropriate and if necessary to ensure patient safety and to meet reasonable cost containment goals, which may include recommendations for statutory changes.

Notwithstanding any General or special law to the contrary, until such recommendations are filed, or until July 1st 2016, whichever occurs earlier, no insurance carrier shall require that a cancer-related or chronic-illness related drug be purchased and delivered to a patient, to a patient’s guardian or representative, or to a patient’s chosen provider only through a third-party specialty pharmacy; provided, however, that nothing in this section shall prohibit a patient or provider, including a home health agency or hospice, from choosing to receive such drugs from a third-party specialty pharmacy. For the purposes of this section the terms “cancer-related drug” and “chronic-illness related drug” shall mean a controlled substance that is indicated for the treatment of cancer or another chronic illness, or for managing the side effects of such treatment, and that must be administered by injection in a clinic, hospital, or physician’s office and which the patient’s treating healthcare provider has determined cannot be reasonably self-administered by a patient to whom the drug is prescribed or by an individual assisting the patient with self-administration; and the term “carrier” shall include those defined in section 1 of chapter 176O as well as health plans that are under contract to the group insurance commission established under Chapter 32A of the General Laws.