Dear Senator Comerford, Representative Decker, and Members of the Committee:

On behalf of the Massachusetts Society of Health System Pharmacists (MSHP) we are writing in strong support of S. 2492 and H. 4109 “An Act Relative to Collaborative Drug Therapy Management Optimization”. 

Collaborative Drug Therapy Management (CDTM) agreements currently permitted under state law allows a qualified pharmacist, under the supervision of a physician to modify, adjust and discontinue medications for several disease states.

The proposed legislation seeks to address a provision in MGL Chapter 112, s.24b 1/2 (C), s.4 specific to CDTM that requires "on-site supervision by the attending physician" in the ambulatory care clinic setting. The "on-site supervision requirement" in the existing statute has been identified to be a significant barrier to new innovative ways of providing CDTM services remotely to patients. Bills S2492/H4109 include language specific to CDTM that require "on-site or off-site supervision by the attending physician" in the ambulatory care clinic setting.

Since the emergence of the COVID-19 pandemic, we have identified that the “on site supervision requirement” in the existing statute to be a significant barrier providing CDTM services remotely to patients.  We believe that consultation and supervision by an off-site supervising physician (using video, audio only, EMR-based secure messaging technology, etc.) would be in line with modern healthcare needs to provide CDTM services remotely.

We urge the Committee to act favorably on S2492/H4109 as soon as possible and look forward to working with the Committee on this legislation.                                       

Thank you again for the opportunity to provide input on this important matter. MSHP welcomes the opportunity to discuss these issues in more detail with your or members of your staff.  If you have any questions or require further information, please feel free to contact me at president@mashp.org

Sincerely,

Russel J. Roberts, Pharm.D., BCCCP, FCCM

President, Massachusetts Society of Health System Pharmacists

September 28, 2021

Senator Brendan P. Crighton, Chair                                        Representative James M. Murphy, Chair

Joint Committee on Financial Services                                   Joint Committee on Financial Services

24 Beacon St.                                                                                24 Beacon St.

Room 520                                                                                      Room 254

Boston, MA 02133                                                                       Boston, MA 02133

Re:  S.695 and H.1199 “An Act Relative to Specialty Medications and Patient Safety.” 

Dear Senator Crighton, Representative Murphy, and Members of the Committee:

On behalf of the Massachusetts Society of Health System Pharmacists (MSHP) we are writing in strong support of S.695 and H.1199 “An Act Relative to Specialty Medications and Patient Safety.” We have serious concerns with “white bagging” and “brown bagging” practices, which the proposed legislation would address.

Patient Safety Concerns/Financial Impacts

 In the coordination between payers and pharmacies to ship a patient’s medications directly to the physician’s office, hospital, or clinic (“white bagging”), the staff is responsible for preparing and administering the products. Healthcare providers are accountable for the quality of care but cannot verify the integrity of medications obtained outside of the established procurement system. Poor coordination can lead to wasted resources and delays in care.  Additionally, pharmacies often lack access to the patient’s electronic health record (EMR) which bypasses the EMR’s medication safety clinical decision support features. Inevitably, it circumvents systems used by healthcare organizations to ensure patient safety[1].

 Other concerns are raised with the practice of dispensing medication from a pharmacy directly to a patient (“brown bagging,”). The patient is responsible for transporting the medication(s) to the physician's office, hospital or clinic for administration which raises concerns regarding the quality control of the medication. Patients may not store or handle the medication properly, especially with temperature restriction; ultimately this may lead to reduced drug efficacy and unsafe medication use[2]. 

 Pros of this Legislation

This legislation explicitly notes that no insurance companies can require a specialty pharmacy to dispense a medication directly to a patient with the intention that the patient will transport the medication to a healthcare provider for administration and that insurance companies “may offer but... not require” use of a home infusion site to dispense sterile intravenous drugs to patients in their homes. This removes the burden from the patient and addresses a quality assurance concern.

The law additionally provides specific requirements for insurers that require distribution of patient-specific medications from a specialty pharmacy to the administration site. One requirement is that providers and patients must be notified well in advice (60 days prior to implementation), which allows for ample time for care coordination. Another requirement is that 24/7 on-call access to pharmacists and nurses must be available; this can help prevent delays in care and ensure patient safety as well. Additionally, the ability to ensure that a drug remains at the appropriate temperature through all stages of supply and storage must be demonstrated, which can reduce product integrity issues.

The specifics of this law address major concerns of white and brown bagging. Ultimately, it provides protection against insurers requiring these bagging methods. The hospital or clinic provision of the medication for administration enhances  patient safety, reduces delays in patient care, and improves product integrity. 

Thank you again for the opportunity to provide input on this important matter. MSHP welcomes the opportunity to discuss these issues in more detail with your or members of your staff.  If you have any questions or require further information, please feel free to contact me.  

Sincerely,

Russel J. Roberts, Pharm.D., BCCCP, FCCM

President, Massachusetts Society of Health System Pharmacists