Patient Protection
Increased Access to Opioid Treatment
There have been many solutions proposed to stop the supply of opioids, but many fail to help those people who are already struggling with opioid-use disorder. The legislature passed a bill this year that exempts medication-assisted treatment (MAT) pharmacological services for substance abuse disorders from prior authorization requirements. The legislation also provides that the medications prescribed for MAT treatments will not be subject to step therapy protocols, and they must be in the insurer’s lowest cost-sharing tier. These new provisions will help patients with opioid-use disorders get on the road to recovery as efficiently as possible.
Immunizations
MSMA supports childhood immunizations to prevent disease and improve public health. A handful of bills addressed immunizations in 2019, two of which were cause for concern to the healthcare community. One bill would have prohibited discrimination against unvaccinated children (effectively requiring schools and medical practices to allow unvaccinated children to attend, even when immunocompromised patients may be present) and the other would have greatly increased the amount of information a health care provider must offer patients prior to administering a vaccine. MSMA testified against both of these bills and will continue to fight bills that seek to undermine the health of Missouri citizens.
Texting While Driving Prohibition
Legislation that would ban texting and driving has struggled for years to get the attention and support it deserves in the Capitol. Several 2019 bills would have created a statewide ban on texting while driving, but they unfortunately ran into staunch opposition from a vocal group of legislators. Our present law allows drivers over 21 years of age to text and drive, despite a lack of scientific evidence to support an age of prohibition. Only two other states don’t currently outlaw this behavior, and the other 47 states have a complete ban on texting and driving. We expect the bill to be proposed once again next year, and MSMA will continue supporting this legislation to make our roadways safer.
Tanning Bed Prohibitions
MSMA joined a broad coalition of healthcare organizations to support this legislation in 2019, which would have put an end to teen tanning bed use in Missouri. Under current state law, a child under 17 years of age must obtain parental consent before they can use a tanning bed or other tanning device. The legislation would have prohibited anyone under the age of 18 from using a tanning bed. It also would have required a trained employee to be present at a tanning facility during operating hours to assist customers and offer information about proper tanning device usage. Though countless dermatologists and skin cancer survivors offered compelling testimony in support of the legislation, several vocal legislators felt that the bill would infringe upon their personal freedom and the bill did not pass.
Sunscreen In Schools
For a couple of years now, legislation has been proposed that would allow students in public schools to bring sunscreen onto school property and to school-related events. Even better, the students would be able to apply it themselves without a prescription from a physician, which schools often require. While there was very little opposition to this commonsense proposal, the bill failed to progress as flashier legislation took center stage. MSMA supported this commonsense legislation.
Motorcycle Helmet Laws
For years and years, every person operating or riding a motorcycle in Missouri has been required to wear protective headgear. Legislation passed in 2019 allows all riders over the age of 18 to ride helmetless as long as they are covered by insurance that provides the rider with medical benefits in case of an accident. Of course a simple health insurance card is proof of insurance, and law enforcement can’t pull anyone over simply to determine if they have the required coverage. Riders who possess a permit but not a full license are still required to wear helmets. MSMA always testifies against this legislation, and we did so again this year. Despite our best efforts, the measure was added into an omnibus bill during the last weeks of session and passed on the session’s final day.
PDMP – St Louis County and Missouri Legislature
Rep. Rehder continued to carry the torch for a statewide PDMP in 2019, but the bill ran into obstacles in the Missouri Senate. We expect the legislature will pick up the issue again next year but until then, the St. Louis County PDMP continues to cover almost 80% of the state’s patients and 92% of the state’s prescribers. We continue to advocate that comprehensive PDMPs like the one in St. Louis are effective tools for physicians to use to combat the opioid epidemic and improve treatment for patients with substance abuse disorders.
Pregnancy-Associated Mortality Review Board
The legislature passed a bill in 2019 that establishes the Pregnancy-Associated Mortality Review Board within the Department of Health and Senior Services (DHSS) to improve data collection and reporting regarding maternal mortality and to develop initiatives that support at-risk populations. The Board will consist of no more than 18 members appointed by the DHSS director, with diverse racial, ethnic, and geographic representation. Beginning in 2020 and every year thereafter, the Board will submit a report on maternal mortality in Missouri and their proposed recommendations to a handful of government entities. DHSS will have the authority to request and receive data for maternal deaths from specified entities, but all individually identifiable information and other records will be kept confidential. Missouri legislators and government agencies alike have been increasingly interested in the topic of preventing maternal mortality. MSMA supported this bill and hopes the information gathered by the Board helps improve maternal health in the state.
Needle Exchanges
A bipartisan 2019 bill would have exempted any entity registered with DHSS that possesses, distributes, delivers, or sells hypodermic needles or syringes from provisions of law prohibiting the distribution, delivery, or sale of drug paraphernalia. Effectively, this bill would have allowed the creation of clean needle exchanges and safe injection sites in the state. Proponents of the bill presented statistics from other states that indicated these programs decrease overdose deaths and reduce instances of preventable communicable diseases related to intravenous drug use, but many legislators are still wary of any program that might help this type of patient. MSMA has policy in favor of the creation of needle exchanges. We expect we’ll see this legislation again in 2020.
Tobacco Cessation Programs
Legislation passed in 2019 that allows pharmacists to provide certain FDA-approved tobacco cessation products to patients without the prescription of a physician. Such products are limited to nicotine-replacement therapies including inhalers, nasal sprays, patches, gums, etc. Although they were included in the introduced version of the bill, oral medications for tobacco cessation must still be prescribed by a physician. The bill requires the Board of Pharmacy and the Board of Healing Arts to jointly adopt regulations governing a pharmacist's authority to provide nicotine-replacement therapy products to patients. MSMA worked with the Missouri Pharmacy Association throughout the legislative session on this issue.
Increased Access to Opioid Treatment
There have been many solutions proposed to stop the supply of opioids, but many fail to help those people who are already struggling with opioid-use disorder. The legislature passed a bill this year that exempts medication-assisted treatment (MAT) pharmacological services for substance abuse disorders from prior authorization requirements. The legislation also provides that the medications prescribed for MAT treatments will not be subject to step therapy protocols, and they must be in the insurer’s lowest cost-sharing tier. These new provisions will help patients with opioid-use disorders get on the road to recovery as efficiently as possible.
Immunizations
MSMA supports childhood immunizations to prevent disease and improve public health. A handful of bills addressed immunizations in 2019, two of which were cause for concern to the healthcare community. One bill would have prohibited discrimination against unvaccinated children (effectively requiring schools and medical practices to allow unvaccinated children to attend, even when immunocompromised patients may be present) and the other would have greatly increased the amount of information a health care provider must offer patients prior to administering a vaccine. MSMA testified against both of these bills and will continue to fight bills that seek to undermine the health of Missouri citizens.
Texting While Driving Prohibition
Legislation that would ban texting and driving has struggled for years to get the attention and support it deserves in the Capitol. Several 2019 bills would have created a statewide ban on texting while driving, but they unfortunately ran into staunch opposition from a vocal group of legislators. Our present law allows drivers over 21 years of age to text and drive, despite a lack of scientific evidence to support an age of prohibition. Only two other states don’t currently outlaw this behavior, and the other 47 states have a complete ban on texting and driving. We expect the bill to be proposed once again next year, and MSMA will continue supporting this legislation to make our roadways safer.
Tanning Bed Prohibitions
MSMA joined a broad coalition of healthcare organizations to support this legislation in 2019, which would have put an end to teen tanning bed use in Missouri. Under current state law, a child under 17 years of age must obtain parental consent before they can use a tanning bed or other tanning device. The legislation would have prohibited anyone under the age of 18 from using a tanning bed. It also would have required a trained employee to be present at a tanning facility during operating hours to assist customers and offer information about proper tanning device usage. Though countless dermatologists and skin cancer survivors offered compelling testimony in support of the legislation, several vocal legislators felt that the bill would infringe upon their personal freedom and the bill did not pass.
Sunscreen In Schools
For a couple of years now, legislation has been proposed that would allow students in public schools to bring sunscreen onto school property and to school-related events. Even better, the students would be able to apply it themselves without a prescription from a physician, which schools often require. While there was very little opposition to this commonsense proposal, the bill failed to progress as flashier legislation took center stage. MSMA supported this commonsense legislation.
Motorcycle Helmet Laws
For years and years, every person operating or riding a motorcycle in Missouri has been required to wear protective headgear. Legislation passed in 2019 allows all riders over the age of 18 to ride helmetless as long as they are covered by insurance that provides the rider with medical benefits in case of an accident. Of course a simple health insurance card is proof of insurance, and law enforcement can’t pull anyone over simply to determine if they have the required coverage. Riders who possess a permit but not a full license are still required to wear helmets. MSMA always testifies against this legislation, and we did so again this year. Despite our best efforts, the measure was added into an omnibus bill during the last weeks of session and passed on the session’s final day.
PDMP – St Louis County and Missouri Legislature
Rep. Rehder continued to carry the torch for a statewide PDMP in 2019, but the bill ran into obstacles in the Missouri Senate. We expect the legislature will pick up the issue again next year but until then, the St. Louis County PDMP continues to cover almost 80% of the state’s patients and 92% of the state’s prescribers. We continue to advocate that comprehensive PDMPs like the one in St. Louis are effective tools for physicians to use to combat the opioid epidemic and improve treatment for patients with substance abuse disorders.
Pregnancy-Associated Mortality Review Board
The legislature passed a bill in 2019 that establishes the Pregnancy-Associated Mortality Review Board within the Department of Health and Senior Services (DHSS) to improve data collection and reporting regarding maternal mortality and to develop initiatives that support at-risk populations. The Board will consist of no more than 18 members appointed by the DHSS director, with diverse racial, ethnic, and geographic representation. Beginning in 2020 and every year thereafter, the Board will submit a report on maternal mortality in Missouri and their proposed recommendations to a handful of government entities. DHSS will have the authority to request and receive data for maternal deaths from specified entities, but all individually identifiable information and other records will be kept confidential. Missouri legislators and government agencies alike have been increasingly interested in the topic of preventing maternal mortality. MSMA supported this bill and hopes the information gathered by the Board helps improve maternal health in the state.
Needle Exchanges
A bipartisan 2019 bill would have exempted any entity registered with DHSS that possesses, distributes, delivers, or sells hypodermic needles or syringes from provisions of law prohibiting the distribution, delivery, or sale of drug paraphernalia. Effectively, this bill would have allowed the creation of clean needle exchanges and safe injection sites in the state. Proponents of the bill presented statistics from other states that indicated these programs decrease overdose deaths and reduce instances of preventable communicable diseases related to intravenous drug use, but many legislators are still wary of any program that might help this type of patient. MSMA has policy in favor of the creation of needle exchanges. We expect we’ll see this legislation again in 2020.
Tobacco Cessation Programs
Legislation passed in 2019 that allows pharmacists to provide certain FDA-approved tobacco cessation products to patients without the prescription of a physician. Such products are limited to nicotine-replacement therapies including inhalers, nasal sprays, patches, gums, etc. Although they were included in the introduced version of the bill, oral medications for tobacco cessation must still be prescribed by a physician. The bill requires the Board of Pharmacy and the Board of Healing Arts to jointly adopt regulations governing a pharmacist's authority to provide nicotine-replacement therapy products to patients. MSMA worked with the Missouri Pharmacy Association throughout the legislative session on this issue.
