Mid-Session Legislative Report
The 2014 "short" session of the Indiana General Assembly is in full swing. Just last week the House and Senate had already entered the "second half" of the 2014 legislative session. While many of the nearly 900 bills filed this session did not survive the first part of session, there are several legislative issues still alive that the IAFP is involved in or monitoring.
A couple of public health bills supported by IAFP's Commission on Legislation are moving forward. Senate Bill 245 (Miller – R) will allow health care providers with prescriptive authority to prescribe auto-injectable epinephrine to a school or school district. The bill sets requirements for school personnel to fill, store and administer the auto-injectable epinephrine and provides civil immunity to health care providers who prescribe or train school employees on the administration of the auto-injectable epinephrine. Senate Bill 50 (Miller – R) will prohibit a person less than 16 years of age from using a tanning device in a tanning facility and will require the Indiana State Department of Health ("ISDH") to adopt standards concerning the use of tanning devices.
Several bills attempting to make ephedrine and pseudoephedrine either legend drugs or scheduled drugs died in the first house. IAFP expressed concern with these bills during the legislative process, citing the burdens that would be placed on all those patients who appropriately use those drugs over-the-counter.
Senate Bill 285 is backed by the Attorney General's Rx Task Force, making insulin a legend drug and tramadol a schedule III controlled substance. The bill's author Senator Ron Grooms, who is also a pharmacist, indicated that over-the-counter insulin is being used inappropriately – both by patients self-diagnosing and treating diabetes, and by individuals seeking to lose weight. And staff from the AG's Rx Task Force indicated that tramadol is becoming one of the most abused and diverted pain medications in the state. During the Public Health Committee, IAFP expressed support for general drug diversion prevention measures, but noted that the scheduling of tramadol could have unintended consequences – such as further dis-incentivizing physicians to treat pain, and actually leading to inadequate pain treatment.
House Bill 1218 (Davisson – R) also addresses pain management regulation, in that it will require the Medical Licensing Board ("MLB") to establish standards and protocols for the prescribing of methadone to treat pain. This bill will also expand the state's INSPECT program to all legend drugs by 2015. IAFP is working with the bill's author to ensure there are exceptions for free samples in thenexpanded INSPECT law.
House Bill 1258 (Shackleford – D) will require the MLB to adopt emergency rules to establish: 1) a pilot program to allow physicians to treat patients without a patient-physician relationship; and 2) establish standards and procedures for physicians in the pilot program. Ultimately, the MLB is required to adopt permanent rules on distance treatment once the pilot program is complete.
On the Medicaid expansion front, none of the three ACA-related bills introduced by legislators received a hearing. The Governor is currently negotiating with the federal government on Indiana's coverage expansion, and has asked that the legislature not pass any legislation that could interfere with his negotiations. He is set to meet with Secretary Sebelius later this month to discuss the state's coverage expansion.
Please watch for another update at the end of the month – this update will capture those bills surviving their "second house". All told, the legislature must adjourn "sine die" by March 14th.