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Taxes, Marijuana, Biosimilars and a Chief Nursing Officer


By Scot Chadwick

​The General Assembly has now recessed for two weeks, but before leaving town, lawmakers acted on several significant health care-related bills.

Property tax reform

The first is important, at least to health care providers, because of what it doesn’t do, rather than what it does. On May 13, the House passed HB 504, legislation that would raise the state’s personal income tax from 3.07 percent to 3.7 percent, and increase the sales tax from 6 percent to 7 percent, with the new revenue to be used for property tax relief.

Whether or not you think that’s a good idea is a subject for another forum, but what is significant in the context of health care is that the bill does not expand the sales tax to new services, including some health care services, as many previous measures have done. The bill now goes to the Senate, where we’ll be watching it very carefully, since previous Senate proposals have included a sales tax on some health care services.

Medical Marijuana

To the surprise of no one, the Senate passed SB 3, the medical marijuana bill, on May 12, by a vote of 40-7. Before approving the bill, the Senate actually broadened it by adding chronic or intractable pain, Crohn’s disease and diabetes to the list of marijuana-treatable diseases that already included cancer, epilepsy, ALS, Cachexia/wasting syndrome, Parkinson's disease, traumatic brain injury and post-concussion syndrome, multiple sclerosis, Spinocerebellara Ataxia (SCA), post-traumatic stress disorder, severe fibromyalgia, HIV/AIDS, and glaucoma.

Senators also voted to allow CRNPs to “recommend” marijuana to their patients pursuant to a written collaborative agreement with a physician. The bill now moves to the House, where leaders have thus far advocated for a bit more restraint on the issue.

Biosimilars

The Senate also acted on the issue of “biosimilars” on May 13, 2015, passing SB 514, legislation that would regulate pharmacist substitution of these new medicines when they become available, by a vote of 39-8.

These substitution safeguards are necessary because biosimilars aren’t like generic drugs. While generic drugs have identical active substances as their brand counterparts, biosimilars are only comparable and are not always scientifically appropriate for substitution.

Because of this important distinction, and to ensure patient safety, the bill requires biosimilars to be licensed and approved by the U.S. Food and Drug Administration, requires pharmacies to provide patients with notice of substitution, and requires notification to the prescriber of substitution.

However, the bill would allow pharmacists to avoid actively notifying the prescriber by simply putting the information in the pharmacy’s own electronic record system, which would be done anyway, as long as that system can be accessed by the prescriber. Without knowing exactly when a prescription is filled, or how soon afterward a pharmacy makes an entry in its system, this could require a prescriber to access a pharmacy’s record system several times over a period of days to find out that a substitution has been made.

Given the novelty of biosimilars and the fact that they are only “comparable” to biologic medications, PAMED does not believe that passive notification sufficiently assures patient safety. For that reason, we believe notification should be active and concurrent with substitution, and we hope to make that change when the bill is considered in the House.

Chief Nursing Officer

I’d be interested to know what you think of this one. On May 11 the House overwhelmingly passed HB 389, legislation that would create the position of Chief Nursing Officer for the commonwealth, akin to the office of Physician General. If enacted, the office would remain vacant when the Secretary of Health is a registered nurse, as is currently the case, so at least for a while nothing would happen.

When the position is ultimately filled, the Chief Nursing Officer’s duties would be to: 
  1. Advise the Governor and the secretary on health policy; 
  2. Participate in the decision-making process of the department on policies relating to all nursing and public health-related issues and in the decision-making process of other executive branch agencies as directed by the Governor; 
  3. Review professional standards and practices in nursing and public health which are related to matters within the jurisdiction of the department and other executive branch agencies; 
  4. Consult with recognized experts on nursing and public health matters which are within the jurisdiction of the department and other executive branch agencies; 
  5. Provide advice on nursing and public health issues to the secretary and to other executive branch agencies; 
  6. Coordinate educational, informational and other programs for the promotion of wellness, public health and related nursing issues in the commonwealth and serve as the primary advocate for these programs; 
  7. Consult with experts in Pennsylvania and other states regarding health care research, innovation and development which relate to programs and issues of importance to the department and the commonwealth; 
  8. Perform such other duties as directed by the Governor; 
  9. When the secretary is not a nurse, serve as a voting member of the State Board of Nursing.

PAMED has not taken a position on the bill, which now moves over to the Senate, but I’d love to know your opinion. Does the office of Chief Nursing Officer have value, and is it a prudent use of the commonwealth’s resources, or is it largely duplicative of responsibilities already carried out by the Secretary of Health and Physician General?

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