The House Committee on Public Health has published their Interim Report to the 84th Legislature. See below for interim charges assigned to the committee and recommendations related to those charges:
Charge I – Prescription Drug Abuse – Assess the prevalence of nonmedical prescription drug use in the state (including opioid analgesics, stimulants, tranquilizers, and sedatives). Identify adverse health impacts. Recommend strategies to curb emerging substance abuse trends among children, pregnant women, and adults, as well as to reduce health care costs and mortality.
Recommendations:
- Make improvements to the state’s prescription drug monitoring program (PDMP) by providing incentives to healthcare providers to use the program without interfering with their ability to administer care according to the accepted standards of their professions, including:
- making prescribing information available in real time;
- developing interoperability with other states;
- implementing an appropriate transition plan of the PDMP from the Department of Public Safety to the Texas State Board of Pharmacy, as described in the report published in December 2010 from the interagency council created by HB 2730 of the 81st Legislature, Regular Session;
- developing a program that identifies suspicious prescriber and patient behavior and alerts prescribers, licensing boards, and law enforcement;
- allowing prescribers to automatically enroll in the PDMP when they renew their license, if not requiring them to;
- creating continuing a medical education program to teach practitioners the benefits of using the PDMP; and
- drafting laws that define a health care provider’s liability for handling a patient’s medical records through the PDMP.
- Provide education to pregnant mothers on Medicaid benefits who are prescribed opioids painkillers.
- Educate the public on the safe storage, use, and disposal of prescription drugs and how to report a pill mill.
- Facilitate take-back programs like those used by the federal Drug Enforcement Agency; increasing state and local take-back programs.
- Expansion of medication-assisted treatment for opioid-addicted individuals, such as Opioid Substitution Therapy (OST), with particular emphasis on appropriate treatment for pregnant women and young users.
- Expand the use of the drug naloxone in a meaningful way that prevents people from overdosing on opiates, and saves lives, including providing the naloxone to first responders or friends and family of addicts.
- Extend the two-year renewal period currently applied to physicians registered with the Controlled Substances Registration established by HB 1803 from the 83rd Legislature, Regular Session, to all prescribers, including advance practice registered nurses.
Charge II – Compounding Pharmacies – Study and make recommendations for improvements to the licensing, regulation, and monitoring of compounding pharmacies, including a review of the joint cooperative efforts between the Texas State Board of Pharmacy, Department of State Health Services, and U.S. Food and Drug Administration. Consider the impact of the passage of SB 1100 (83R), additional appropriations made by the 83rd Legislature to strengthen inspections, and any relevant federal legislation.
Recommendations:
- The recommendation of the Public Health Committee would be to create more efficient and transparent processes for the use of compounding pharmacies by beneficiaries of public health care.
Charge III – Electronic Health Information – Identify strategies to support the efficient exchange of electronic health information with Texas Health and Human Services enterprise agencies. Examine legal and technical issues around the accessibility of information held in registries maintained by state agencies to authorized health care providers. Identify issues related to health information exchange and providers' liability, as well as concerns related to transitioning patient data in cases where a provider selects a new electronic health record vendor.
Recommendations:
- The Legislature should clarify its intent in statute on the interoperability of state registries with health information exchanges (HIE’s).
- The Legislature should update liability standards for handling health records that contemplates the electronic sharing of records between providers, electronic records platform vendors, and health information exchanges.
- Strengthen and clarify notification requirements for patients regarding their protected health information (PHI) created, retained, or disclosed by the state, including PHI to state public health registries. Provide clear and consistent guidance to agencies and providers on the means of obtaining authorization by patients if this data will be created or disclosed for particular purposes described in Chapter 181 of the Health and Safety Code added by HB 300 (82nd Session).
- The state should seek to alleviate the administrative burden for health care providers who access the state’s public health registries. If one online portal is created to access registries, the Legislature should contemplate and provide guidance on the possibility for providers to receive health information from the registry via the portal.
Charge IV – Biologics & Biosimilars – Examine the current practice for dispensation of biologic and follow-on biologic (biosimilar) pharmaceutical products in our state. Review any practices for interchangeability of drugs that might pertain to these particular medicines. Review and make recommendations regarding the substitution of biosimilar and biologic medicines.
Recommendations:
The Food & Drug Administration (FDA) has not yet released a definition of interchangeability of biologics and biosimilars, but a bill should be in place when the FDA announces their decision. This bill would adopt the federal definitions of a biological product, a biosimilar product, an interchangeable product, and a reference product. A proactive bill should be enacted that ensures safety and affordability for the patient. If the price of an interchangeable biosimilar is lower than a patient’s copayment, the patient should be allowed the option of paying for the cheaper alternative. Before dispensing an interchangeable biosimilar, the pharmacist would have to notify the patient an alternative product was available and allow the patient to choose between that product and the prescribed brand. If a substitution does occur, an update of the patient’s electronic medical records by the pharmacist would complete their medical record and could suffice as a notification as long as the practitioner also has access to these records. These records must be updated within one to two weeks of the substitution. A practitioner does have the option to write “as prescribed only” on the prescription which would not allow for a substitution to occur. Likewise, the pharmacist who selected an interchangeable biosimilar product would assume the same responsibility as when filling a prescription for a biological product. A pharmacist could select an interchangeable biosimilar product only if it was less expensive than the prescribed product. A pharmacist could not charge a higher fee for dispensing interchangeable products than for brand name products. A two year sunset clause for the notification process is not necessary.
Charge V – Immunization Registry – Monitor transition of the state's immunization registry to a new system. Determine whether the registry can be better utilized to prevent and/or respond to communicable disease outbreaks, including pertussis. Identify potential factors contributing to the rise in the number of pertussis cases and strategies to prevent future outbreaks.
Recommendations:
- Ensure that Texas maintains a robust vaccine registry that can direct better resources during adverse events as well as ensure that citizens are neither over- nor under vaccinated.
- Alleviate administrative deterrents to health care providers using ImmTrac, the state’s vaccine registry.
- Evaluate the ease by which immunization exemptions are received by school age children and track exemption data to use in the event of possible outbreaks.
- Improve outreach to children reaching the age of consent, before their records are purged from ImmTrac on their 18th birthday.
- Improve public education on the potential benefits and harms from vaccines with a particular emphasis on vulnerable populations like pregnant women or unvaccinated adults living in a household with infants too young to be inoculated for diseases like pertussis.
- Expand best practices available to physicians such as post exposure prophylaxis antibiotics for those in contact with infected individuals that will not require them to visit the treating physician.
Charge VI – Implementation of 83rd Legislation – Conduct legislative oversight and monitoring of the agencies and programs under the committee’s jurisdiction and the implementation of relevant legislation passed by the 83rd Legislature, including HB 15 (83R). In conducting this oversight, the committee should:
- consider any reforms to state agencies to make them more responsive to Texas taxpayers and citizens;
- identify issues regarding the agency or its governance that may be appropriate to investigate, improve, remedy, or eliminate;
- determine whether an agency is operating in a transparent and efficient manner; and
- identify opportunities to streamline programs and services while maintaining the mission of the agency and its programs.
No Recommendations
