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Last week, Gov. Gavin Newsom captured national attention when he announced California’s intention to produce its own generic drugs, building on earlier state efforts. Last year, the governor issued an executive order charging public payers to combine their purchasing power to negotiate better prices, and to eventually expand to include other payers in the state.
The idea to produce generics has roots in the efforts of 10 health systems, including Intermountain Healthcare, Mayo Clinic Health System, Providence, and Trinity Health, among others, that came together to address generic drug shortages and rising prices. With support from Arnold Ventures, the Peterson Center on Health Care, and the Gary and Mary West Foundation, they launched the nonprofit Civica Rx in 2018.
The Civica Rx business model currently contracts with foreign drug manufacturers and takes advantage of a new US Food and Drug Administration (FDA) provision – Abbreviated New Drug Applications – that expedites the approval process for certain drugs. Civica Rx has its own National Drug Code and through this process can assure that foreign-manufactured drugs meet FDA standards for safety. Currently, 18 drugs are in production, including naloxone, steroids, drugs to prevent side effects from chemotherapy, and the beta blocker metoprolol tartrate, used to treat high blood pressure.
Through Civica’s contract with London-based Hikima, the third-largest supplier of injectable generic drugs, the anticoagulant drug heparin sodium is now sold to participating hospitals. Through the Danish company Xellia Pharmaceuticals, two injectable antibiotics are also available. Civica reports that it currently serves 1,200 US hospitals and that participating hospitals agree to:
- Pay the same price for each drug;
- Price transparency; and
- The same contract terms.
Civica’s model is designed for and by hospital systems to make sure they have needed generic drugs that they can provide directly to patients. A state model that follows the Civica Rx template is expected to take into consideration costs, distribution channels, and other logistics to assure these generics can be provided safely and at lower costs to payers and consumers.
There are assuredly lessons to learn from the success of Civica Rx, and all eyes are now on California to lead the way for states.
Each year, NASHP publishes more than 100 reports and resources to give state leaders the information they need to craft effective legislation and health policies. Below are our most-read resources of 2019.
- Rx Legislative Tracker: This resource with its map interface gives you the status of every state’s legislation to curb prescription drug costs since 2015, and it’s updated weekly.
- Is it Safe and Cost-Effective to Import Drugs from Canada? NASHP created model legislation for states to use to implement wholesale drug importation from Canada. This infographic explains why it’s safe.
- A Snapshot of State Proposals to Implement Medicaid Work Requirements This resource provides descriptions of states’ proposals to implement Medicaid work requirements nationwide.
- A Glossary of All Terms Pharma If you want to tackle drug costs, you need to know the pharmaceutical industry’s lingo. This glossary helps demystify pharma’s verbiage.
- State Community Health Worker (CHW) Models States are funding, training, and certifying CHWs to help coordinate care, promote access to community services, and address social determinants of health. This resource shows what individual states are doing.
Since 2017, the National Academy for State Health Policy has worked with states to develop and implement effective model policies to lower prescription drug prices. This slideshow highlights states’ administrative and legislative actions, including Medicaid innovations and more than 120 new laws that promote pharmacy benefit manager regulation, drug price transparency, wholesale drug importation from Canada, and drug affordability review.
The Administration for Community Living is requesting information from individuals and organizations to assist the RAISE Family Caregiving Advisory Council in developing goals, objectives and recommendations for an initial report to Congress and national family caregiving strategy, which are required by the RAISE Family Caregivers Act of 2017. The input will also help the council plan public listening sessions. To submit comments, click here. The deadline to submit recommendations is Feb. 7, 2020.
To tackle the opioid epidemic, which has been the leading cause of unnatural deaths since 2013, Virginia recently developed an integrated physical and behavioral health continuum of care, which spans multiple treatment settings and includes case management and peer recovery support. The initiative, combined with increased access to naloxone and other efforts, has helped reduce fatal overdoses by 3.3 percent between 2017 and 2018.
In March 2016, with support from Virginia Gov. Terry McAuliffe, the Virginia General Assembly passed appropriations mandating transformation of the SUD Medicaid benefit entitled the Addiction and Recovery Treatment Services program or ARTS, which was implemented on April 1, 2017. Early results from Virginia’s ARTS program indicate success in increasing access to care for Medicaid-eligible pregnant women with SUD and opioid use disorder (OUD).
Data obtained from pre-ARTS implementation (covering April 2016-March 2017) compared to post-ARTS implementation (April 2017-March 2018) indicate that the percent of Medicaid-enrolled pregnant women with SUD who received treatment increased from 2 percent to 21 percent, while the rate of pregnant women with OUD who received treatment increased from 4 percent to 31 percent. In addition to increasing treatment rates, the number and types of treatment providers and treatment programs available to pregnant women with SUD and OUD also increased significantly in the post-ARTS implementation period.
Ashley Harrell, senior program advisor with Virginia’s Department of Medical Assistance Services (DMAS), recently shared the goals and highlights of the program with the Maternal and Child Health Policy Innovation Program (MCH PIP) Policy Academy, hosted by the National Academy for State Health Policy (NASHP). The academy, made up of eight cross-sector state teams, focuses on the mental health needs of pregnant and parenting women, particularly those with or at risk of substance use disorder (SUD). The ARTS program has six major goals:
- Expand the short-term SUD inpatient detox benefit to all Medicaid/FAMIS enrollees (FAMIS is Virginia’s health insurance program for uninsured children);
- Expand short-term SUD residential treatment to all Medicaid enrollees;
- Increase reimbursement for existing Medicaid/FAMIS SUD treatment services;
- Add peer support services for individuals with SUD and/or mental health conditions;
- Require SUD care coordinators for DMAS-contracted managed care plans; and
- Organize provider education, training, and recruitment activities.
The Virginia state Medicaid agency has made additional policy changes to improve access to care for pregnant enrollees with SUD. Some of these changes include:
- Allowing and encouraging same-day billing of medical and behavioral health services;
- Requiring access to medication-assisted treatment (MAT) along the addiction care continuum; and
- Removal of prior authorization requirements for up to 24 mg/day of Suboxone film for in-network buprenorphine-waivered practitioners.
Additionally, the Virginia Medicaid MEDALLION 4.0 has an embedded High-Risk Maternity Program that includes comprehensive care management and family planning services to women with SUD. MEDALLION 4.0 is a statewide, fully capitated, risk-based, mandatory managed care program for Medicaid and Family Access to Medical Insurance Security (FAMIS) members that operates under the authority of a §1915(b) waiver. MEDALLION 4.0 covers pregnant women, infants and children and provides acute and primary health care services, prescription drug coverage, and behavioral health services for their members.
Harrell’s presentation spurred much discussion among academy participants, who quickly shared their concerns about access to care, integration of services, health equity, and the long-term health outcomes of women, children, and families affected by SUD.
Over the next two years, NASHP academy participants will continue to learn from each other and from subject matter policy experts as they strive to develop, support, and advance state-level policy innovations for pregnant and parenting women with or at risk for SUD and/or mental health conditions. Understanding state innovations is key to identifying new strategies to leverage change. As one policy academy participant observed during the meeting, “No one [state] has all the answers, but we have a lot of resources in each other.”
For more information on the academy, read NASHP’s blog, New Eight-State Policy Academy Advances Access to Care for Pregnant/Parenting Women with SUD. For more information about the Virginia ARTS program, visit the Virginia DMAS ARTS website or email questions about the ARTS program to firstname.lastname@example.org.
During 2019, the National Academy for State Health Policy (NASHP) has tracked the progress of many of the plans governors outlined in their 2019 state of the state and inaugural addresses that focused on the social and economic factors that influence health. The governors’ initiatives included social inequity, housing, education, the environment, jobs, and other priorities.
In addition to identifying new initiatives, 10 governors unveiled plans to reconfigure their cabinets to better address the conditions that affect health. They proposed cross-agency and public-private collaborations to leverage siloed state resources and coordinate services more efficiently.
In recent months, NASHP has highlighted states that have followed up with initiatives and policies to implement their governors’ and legislatures’ shared goals through the use of executive orders, legislation, or budget appropriations. These analyses are captured in the following NASHP blogs that provide a snapshot of some of the innovative approaches states are taking:
- States Take the Lead to Address Climate Change, December 2019
- Minnesota and Indiana Governors Work to Improve Social Equity and Health in Every Zip Code, September 2019
- States Take Action to Improve Health through Housing, August 2019
- States Take Action to Improve and Expand Early Childhood Education, June 2019 and
- Across the Nation, State Leaders Are Tackling the Global Issue of Environmental Protection, May 2019
In 2020, NASHP looks forward to following these and other innovations as state leaders identify new approaches and take additional actions. NASHP seeks to showcase states that are looking upstream to tackle these issues. Please email email@example.com information about your state’s progress so we can share your accomplishments nationally.