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House bill targets mail-order drugs
A House of Delegates proposal targeting copay discounts for mail-order prescriptions could yield near-term savings but have long-term costs for the state and its workers by driving more of them to retail pharmacies.
Among the potential beneficiaries of the proposed policy change: many of Virginia’s roughly 950 retail pharmacies, including one run by Del. Chris Jones (R-Suffolk).
Jones is chairman of the budget-writing House Appropriations Committee, whose amended version of the two-year, $96 billion budget directs the state to plan for proportional parity between copays from retail pharmacies and mail-order pharmacies.
Jones said he had no role in developing that language in the bill bearing his name — Del. Chris Peace (R-Hanover County) proposed it.
Del. Keith Hodges (R-Middlesex County) also runs an independent pharmacy. Jones voted for the budget bill in committee, but he and Hodges abstained from a vote on the pharmacy amendment when the bill came to the House floor.
Traditionally, Virginia has given an incentive to covered employees and dependents who use mail-order services, often for medications to maintain chronic conditions such as high blood pressure, cholesterol and diabetes.
The rationale is that it saves money: It reduces the number of claims processed, and the state often gets a better deal on drugs through bulk buying.
The $202.8 million Virginia spent in fiscal year 2013 on prescription drug claims was about one-fifth of the $966.8 million it spent that year on total health care claims, not including administrative costs. More than 200,000 people — public employees and their dependents — are enrolled in a state health benefits plan.
The introduced budget raised copays for all non-generic prescriptions but maintained the mail-order discount, essentially providing a one-month copay rebate. It proposed a $5 bump for a 30-day retail supply; a suggested $10 increase for a three-month order by mail in effect leaves the mail-order discount in place even as overall copays rise.
That plan was estimated to save the state $9 million annually. A fiscal impact report on the House amendment estimates further annual savings of $240,300.
As written, the House language would raise the retail copay rate $5 for a one-month supply and the mail-order price $15 for three months of medication. Mail-order copays would still be cheaper in that scenario, but the price difference between them and retail rates would shrink.
The House budget also directs the state human resource agency to study a plan for “proportional parity between co-pay amounts for retail pharmacy services and home delivery pharmacy” that can be in place by July 1, 2015.
Proponents such as Peace said “there are significant savings to be had by putting retail pharmacy on equal footing.”
To back that up, he cited a study by a Virginia Commonwealth University School of Pharmacy professor comparing retail and mail-order prescription costs that concludes health plan sponsors didn’t “realize savings by using mail order pharmacies.”
Sara Wilson, director of Virginia’s Human Resource Management Department, declined to comment. But during testimony on the House pharmacy proposal at a January subcommittee hearing, Wilson told legislators that each 1 percent shift to retail by current mail-order users has a $250,000 cost that either the state or covered employees will pay.
That would equate to nearly $4.4 million if all 17.5 percent of state plan participants who now use mail order convert to retail.
Pharmacist Faiz Oley, owner of Westbury Pharmacy in Richmond, considers Wilson’s forecast incomplete, saying it doesn’t “reflect any savings from lower utilization and better outcomes” for patients.
Other benefits patients get in retail pharmacies? Face-to-face consultations with trained professionals, and medications dispensed in controlled settings without the risk of delivery problems, said John Norton of the National Community Pharmacists Association.
Hodges, the delegate who owns Gloucester Pharmacy, said he is sympathetic to the House amendment’s intent and believes it could save the state money.
“It creates parity,” he said. “It allows freedom of choice for the consumer.”
Jones said prescription benefits managers “for years have tried to drive people to mail order,” even though studies show savings often aren’t realized.
The House plan came through the Appropriations panel’s Compensation and Retirement subcommittee, a body Jones once chaired.
The Senate budget bill doesn’t include the pharmacy provision.
Regulating Older Drivers
Drivers 75 and older would face more strict standards to renew a license for five years, instead of eight, under legislation that passed the Virginia Senate last month, weeks after the chamber rejected a similar bill.
The measure (HB771) from Del. Tim Hugo (R-Fairfax County) would lower from 80 the age at which older drivers face mandatory vision tests and are eligible for only the shorter license renewal period.
The legislation approved on a 30-5 vote also would establish a mature-driver, crash-prevention course to which a court could send older drivers after traffic infractions.
Some critics say the bill unnecessarily singles out older drivers.
While serious crashes involving older drivers often merit headline news, Sen. Dick Black suggested those involving teens are just as prevalent but less scrutinized. Restricting senior driving privileges, said the Loudoun County Republican, inhibits their ability to get around and essentially makes them “caged.”
Speaking in favor of the bill, Sen. Adam Ebbin cited statistics indicating elderly drivers are more prone to accidents than younger drivers.
“I’m more concerned with the drivers who are on the roads who physically can’t see well and can’t react well,” said Ebbin (D-Alexandria).
Sen. Dave Marsden (D-Fairfax County) referenced his mother’s struggle with Alzheimer’s disease in defense of an idea he said could act as a way to convince older drivers to “relinquish the wheel.”
It is unclear whether Gov. Terry McAuliffe supports the bill now heading to him; a McAuliffe spokesman did not immediately respond to an inquiry.
Flexible SOL Testing Dates
Legislation that would have ditched the state’s spring testing dates and let school divisions decide when to test which students seemed to be gaining support and momentum.
Then last week, it died in appropriations.
A group of Virginia school superintendents had pitched the General Assembly an idea that those students ahead in their studies could take the test early in the school year, while the course material was fresh in their minds, and move on to more advanced learning. Meanwhile, struggling students could wait and be tested later.
Steve Staples, executive director of the Virginia Association of School Superintendents, said the committee that decides whether bills will be funded thought the measure could be too expensive, possibly because more test questions would be needed.
But there’s hope in how far SB388 progressed this year, he said. It passed the full Senate and an amended version got through the House Education Committee. Legislators in both parties seem to understand the need for it, Staples said.
“The simple argument is, students should be tested when they’re ready,” he said. “Now, we’re giving students tests we know they’re not prepared for.”
The bill’s patron, Sen. George Barker (D-Fairfax County), said he’ll try again next year.
Barker sponsored the same bill last year, and it was killed then, as well. But in the meantime, the idea has gained traction, he said, most notably from the state Department of Education, which this year did away with its practice of offering three test date options. Instead, schools can test anytime from mid-April through nearly the end of June.
That’s an improvement, Barker said, but he’d still like schools to be able to test at times that are best for children who learn at different paces.
“It’s a true benefit for these students,” he said.
A bill banning teen tanning died in the House Commerce and Labor Committee on Feb. 27.
Sen. George Barker’s SB479 would have banned children under 15 from tanning beds and required teens ages 15 to 17 to get parental permission. The committee voted to continue it until the 2015 session.
Stronger bills to further limit teenage tanning died earlier in the session.
Help for Diabetic Students
The House Education Committee last week debated whether it’s a good idea to make local school boards let diabetic children carry their own supplies and make them train some school personnel to administer insulin and glucagon, as outlined in SB 532.
The bill goes further than a similar one (HB 134) the House already passed, and it creates more liability for schools, those in opposition said. They also said it adds to a long list of things schools are asked to do besides teach.
“We cannot ask our teachers to be everything to everyone, all the time,” Del. Tag Greason (R-Loudoun) said.
Those in favor countered the bill only enforces what schools are already supposed to do.
The committee approved the bill, 12-8, and sent it to appropriations for funding consideration.
Equal Rights Rejected
The Equal Rights Amendment: artifact of history or burning contemporary issue?
After a 30-minute debate resonant with professed respect for the pioneers of civil rights, a Republican-controlled House of Delegates subcommittee on Feb. 27 did what it always does with the ERA: consigned the measure to the legislative dustbin.
The ERA, adopted by Congress in 1972, declares: “Equality of rights under the law shall not be denied or abridged by the United States or by any State on account of sex.”
The amendment has been ratified by 35 states – three short of the number needed to enshrine it in the U.S. Constitution. Nearly every year, a proposal is introduced to ratify it in Virginia.
The patron of this year’s measure (SJ78) was state Sen. Henry Marsh (D-Richmond), a Virginia civil rights legend. Now 80, he was an early leader of the movement to end racial segregation of public schools and was the first African American mayor of Richmond.
It’s past time to assure equal rights for women, Marsh told the House lawmakers, urging them to “recognize and join the movement of history.”
Republicans on the seven-member panel were profuse in their praise of Marsh’s legacy before moving to kill his bill, which passed the Senate earlier this month on a bipartisan 25-8 vote.
The committee room was packed with women supporting the measure, several of whom related accounts of being paid less than similarly qualified men and being denied opportunities for promotion that were afforded their male counterparts.
Republicans assured the crowd they support equality for women, but asserted that it already has been achieved without the ERA. They also argued the measure is null and void because it contains a 1982 deadline for ratification.
The subcommittee chairwoman, Del. Margaret Ransone (R-Westmoreland County) is 40. She had not been born when the ERA was adopted by Congress. She hailed the ERA supporters in the room for their activism, saying they helped her achieve her position in a once all-male legislature.
“I’ve never felt like I was discriminated against,” Ransone said. “Thank you for what you’ve accomplished. You’ve done it already.”
“No!” several women in the audience cried out.
Ransone then voted with her fellow Republicans to kill the bill on a 5-2 party-line voice vote.
“This is an insult,” said one woman in the crowd as the meeting ended.
For at least another year, Virginia will remain the only state in the country where it’s legal to tailgate a bicycle.
An attempt to revive HB82 failed in the Senate Transportation Committee last week. The measure would have prohibited following a bicycle “more closely than is reasonable and prudent.”
All 49 other states extend that protection to bicyclists.
A similar measure passed the Senate last year, only to die in the House of Delegates.
But confusion reigned when the bill was reconsidered Wednesday. Expressing concerns about the measure’s enforceability, the panel shunted it to the Joint Commission on Transportation Accountability, an obscure study group.
Bicycling enthusiasts were dismayed. “We should be entitled to the same rights and protections as all other users of the roads,” said Tom Bowden, chairman of Bike Virginia.
Your next state auto safety inspection could include testing the tint of your windows.
A bill (SB408) to add window tint to the annual inspection checklist is moving toward passage in the General Assembly.
The measure has passed the Senate 38-0 and was approved by a House of Delegates subcommittee 5-2. It now advances to the full House Transportation Committee.
State law prohibits window tints that reduce light transmittance to less than 50 percent on front windows and less than 35 percent on rear windows.
No E-Cigs for Minors
Legislation banning the sale of electronic cigarettes to minors was passed unanimously by the General Assembly last month.
The products resembling real cigarettes deliver nicotine in vapor form.
The legislation (SB96, HB218) was approved 40-0 in the state Senate and 99-0 in the House of Delegates and goes to Gov. Terry McAuliffe for his signature.
Electric Chair Bill Short-Circuits
The debate over allowing the state to use the electric chair if the lethal injection drug isn’t available is over. For now.
A Senate committee continued HB 1052 to the next session, meaning its next chance for approval will be in 2015. The Senate shelved another bill (SB 607) by sending it back to committee.
Bill patrons had said the state was experiencing a shortage of the drug used for lethal injection and even though prisoners on death row — there are eight right now — get to choose their method of death, the state should be allowed to proceed with the electric chair to move cases forward.
Del. Jackson Miller (R-Manassas) said a new drug cocktail has been found, and the shortage averted, but the bill is still needed in case of another shortage.
But because the Senate already declined to vote on the Senate bill, Sen. Emmett Hanger (R-Augusta) suggested delaying Miller’s bill until next year. The committee agreed.
Legislation is advancing in the General Assembly to let nonviolent felons sentenced to short jail terms do their time on weekends.
The measure would make it easier for those offenders – many of them convicted of drug possession – to remain employed or in school, reducing the likelihood that they will break the law again, Sen. Bill Stanley (R-Franklin County) told a House subcommittee.
Stanley’s bill (SB167) applies to felons with 120 days or less to serve. Judges could sentence them to weekend time as long as the prosecutor agrees.
The measure, which passed the Senate 39-1, was approved unanimously by the House panel.
Teen Cellphone Use
An attempt to crack down on cellphone use by teenage drivers was stopped in its tracks by a House of Delegates subcommittee.
Sen. George Barker’s bill (SB139) would have made it a primary offense for a person under 18 with a provisional driver’s license to use a cellphone while behind the wheel.
Such activity is already illegal, but it’s a secondary offense, meaning it can’t be enforced unless the driver has been stopped for another violation.
Barker (D-Fairfax County) told the subcommittee that savvy teenage drivers, knowing they can’t be pulled over for using a cellphone, are openly flouting the law.
“They’ll sometimes pull out of the high school parking lot waving their cellphone at the officer directing traffic,” he said.
Martha Meade, a lobbyist for the AAA drivers club, said the current law creates a “disrespectful dynamic” between teenagers and police.
“I think that by not making this a primary law, we are sending a message to our teens that this must not be dangerous – it must not be something that the police or lawmakers are taking seriously,” Meade said.
Last year, the General Assembly made texting while driving a primary offense. The tougher law has produced a remarkable change in behavior, Barker said, citing a survey by AAA that found that two-thirds of those who previously texted behind the wheel have stopped doing so.
Barker’s bill, which barely squeaked out of the Senate thanks to a tie-breaking vote by Democratic Lt. Gov. Ralph Northam, was rejected by the Republican-controlled House panel on a party-line voice vote.
No-Excuse Absentee Voting for Seniors
An attempt to allow no-excuse absentee voting by senior citizens was foiled in the Virginia House of Delegates.
Like all other voters, senior citizens are allowed to cast absentee votes only by giving one of several excuses laid out in current state law, such as disability, business travel or military service.
The legislation (SB16) would have allowed anyone 65 or older to vote absentee without giving an excuse. The measure passed the Senate last month on a 28-10 vote.
A Republican-controlled House subcommittee rejected it on a voice vote.
No Parole for Juvenile Offenders
An attempt to give some juvenile offenders serving life without parole for nonhomicide crimes a chance to appeal their sentences is over — for now.
SB142 would have allowed teens sentenced to prison past their 60th birthday to petition the state Supreme Court for less jail time once they had served at least 20 years or turned 35 years old.
But the House Criminal Law Subcommittee on Feb. 28 voted to push consideration back to the 2015 legislative session. The bill’s patron, Sen. Dave Marsden (D-Fairfax), said that’s what he expected.
Virginia doesn’t allow parole for good reason, said Del. Rob Bell (R-Albemarle County): By the time an offender makes his appeal, the victim, officers, prosecutors and others involved may have died or moved away.
“The best time to establish proper sentencing is at sentencing,” said Bell, chairman of the committee. He added that the 58 inmates who could be eligible for shortened sentences under SB142 committed crimes involving weapons, abduction, rape, robbery and assault.
“These are our most serious young offenders, who commit our most serious crimes,” he said.
Marsden’s bill made headlines in part because of Travion Blount, a Norfolk man convicted of armed robbery and given six life terms plus 118 years. In January, then-Gov. Bob McDonnell commuted his sentence to 40 years.
Blount was 15 when he joined two young men in an armed robbery of a house party. No shots were fired and Blount physically injured no one. His co-defendants pleaded guilty and were sentenced to 10 and 13 years.
Blount refused a similar plea agreement and went to trial. He received what may be the longest punishment in the country for a juvenile convicted of a nonhomicide crime and now has an appeal in federal court.
Marsden had said previously that Blount’s case demonstrates why his bill is needed.
He added that a case pending in federal court may declare Virginia cannot continue its practice of sentencing juveniles to life without parole for crimes that don’t involve a death. If that happens, he told the subcommittee, the state will need to revisit its law.