Vermont's Vaccination Saga

Senator Kevin Mullin shared a fascinating report at the summer meeting on his efforts to remove the parental philosophical objection provisions in Vermont law and boost vaccination rates in his bill, S199. Senator Mullin recounted Vermont's experience from the earliest days of the state's history when local hero Ethan Allen was vaccinated for smallpox to the success in nearly wiping out polio with routine vaccinations, to today, when vaccination rates are sliding, posing real public health risks. While his original bill did not pass both the Senate and House, the latter which opposed removing the philosophical objection, Senator Mullin was able to pass a stripped-down data collection version of S199, that reads as follows: Sec. 1. 18 V.S.A. § 1121 is amended to read: § 1121. IMMUNIZATIONS REQUIRED PRIOR TO ATTENDING SCHOOL AND CHILD CARE FACILITIES *** (c) To the extent permitted under the federal Health Insurance Portability and Accountability Act, Pub. L. 104-191, all schools and child care facilities shall make publicly available the aggregated immunization rates of the student body for each required vaccine using a standardized form that shall be created by the department of health. Each school and child care facility shall annually, on or before January 1, submit its standardized form containing the student body's aggregated immunization rates to the department of health. Notwithstanding section 1120 of this title, for the purposes of this subsection only, the term "child care facility" shall exclude a family day care home licensed or registered under 33 V.S.A. chapter 35.

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For more information:

Sharon Anglin Treat, NLARx Executive Director
207-622-5597
streat@reducedrugprices.org

Trade Policy & Pharmaceuticals:

The Korea-US Free Trade Agreement (FTA) and Australia-US FTA included provisions for the first time that directly addressed drug pricing for reimbursement purposes by government health programs like Medicaid. These provisions were applicable to the U.S. as well as our trading partners, but a footnote in the Korea agreement, which was strongly advocated for by NLARx and governors in several U.S. states, clarified that Medicaid rebates would not be affected by these provisions. Now the U.S. government is involved in negotiations over the 9-country TransPacific Partnership or TPP trade deal (soon to be 11 countries), and similar provisions have been proposed. These provisions are being advocated for by PhRMA and the biomedical and medical device industries, and would limit how effectively governments can negotiate prices. Once again, NLARx and a number of states have objected to this languagewhich seems intended to drive drug prices ever higher, and which also includes provisions that raise safety concerns. Although the US government has indicated an interest in again "carving out" Medicaid, state legislators worry that other safety net programs such as 340B will be caught in this net.

There are some useful new materials to help understand this issue. At the NLARx meeting in Burlington, Executive Director Sharon Treat presented on the TPP issues. In addition, a recent report commissioned by the Maine Citizen Trade Policy Commission analyzed the potential impact of these pharmaceutical provisions on the Maine Medicaid program, and other states would be similarly affected. Finally, although not limited to pharmaceutical issues, a resolution finally passed July 15 by the NCOIL International and Executive Committees calls for more consultation with state legislators and greater transparency in the TPP and other trade negotiations.

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Wither the Affordable Care Act?

With all the focus on the individual mandate and Medicaid expansion provisions of the Affordable Care Act, relatively little attention has been paid to the multitude of provisions in the Act that affect pharmaceutical policies including pricing, reimbursement, benefit management and marketing. Yet there is a lot there, and there are potentially opportunities for legislators to expand some existing state programs and look for alternative ways to implement other policies such as PBM transparency, disclosure of gifts and payments to physicians, datamining, academic detailing and more. NLARx Executive Director Sharon Treat presented briefly on many of these provisions, and the legislators and legislative staff present agreed that a future NLARx meeting should be devoted to exploring the ACA and the opportunities for state legislators to expand on policies in the Act, such as marketing disclosure, and potentially to use the rules of the Exchanges to promote greater transparency in PBMs as well as to fine-tune data and electronic record privacy provisions.     

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More Spotlights on Affordable Care Act Here