New AMA model state legislation
The AMA Board of Trustees last week approved several new AMA model state bills. AMA staff will soon hold a call with the nation's medical societies to go into more detail about the model bills.
The "Pharmaceutical Costs Transparency Act" would help improve affordability of drugs for patients. The black-box nature in which pharmacy benefit managers (PBMs) operate is frustrating and costly to physicians, pharmacists, and patients. For example, a PBM's drug formulary may force consumers to spend more on their cost sharing for a drug than what they would have spent if they purchased the drug without insurance.
So called "gag clauses" in pharmacy-PBM contracts can bar pharmacists from telling consumers about less expensive options, such as not using their insurance. In addition, "clawback" provisions can allow PBMs to take back the difference between a higher copay amount and a lower negotiated rate. This model bill prohibits these practices.
The "Ensuring Access to High Quality Care for the Treatment of Substance Use Disorders Act" would increase access to medication assisted treatment (MAT). This is a revision to an existing model bill to provide current data and add new provisions to help promote treatment in a wide variety of settings.
This model bill provides that all relevant administrative delays used by health insurers would be prohibited, ensures parity compliance and reliance on evidence-based guidelines for the treatment of substance use disorders, updates language concerning formularies, and adds correctional facilities and drug courts to the entities that must provide MAT. The updated model bill also addresses requirements for network adequacy and includes patient protections for out-of-network care as well as enforcement mechanisms from relevant state entities.
The "Joint Regulation of APRNs Act" establishes a structure by which a state can create a joint regulatory board composed of members of the boards of medicine and nursing, tasked with licensing and regulating APRNs. In addition to establishing the legislative framework for this joint regulatory scheme, the model bill includes an Appendix with sample language to utilize in drafting regulations that result from the model being signed into law.
The "Team Based Care Act," first released in 2014, requires nurse practitioners to practice as part of a physician-led patient care team. Based on landmark Virginia legislation, the model bill defines a "patient care team" as a multidisciplinary team of health care providers actively functioning as a unit with the management and leadership of the team handled by one or more patient care team physicians for the purposes of providing health care to a patient or group of patients.
Within these teams each member has specific responsibilities related to the care of the patient or patients and shall provide health care services within the scope of his or her usual professional activities. The model bill also establishes a process through which NPs gain the authority to prescribe certain controlled substances. The model bill was revised to reflect the new Joint Regulation of APRNs Act and to incorporate modifications Virginia made to its model since adopting its landmark legislation.
To receive a copy of these or other AMA model bills, email the AMA Advocacy Resource Center.
More articles in this issue
- April 19, 2018: Advocacy spotlight on AMA, specialty societies ask CMS to reduce 2018 MIPS reporting period
- April 19, 2018: National Advocacy Update
