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(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

Health Policy Commission

Agency on Aging

SUMMARY

Synopsis of Bill

HJM 9 calls for a joint effort between the state Primary Health Care Association, the University of New Mexico Hospital, the State Hospital Association and other interested parties to examine opportunities that allow Federally Qualified Health Clinics (FQHCs) to fill prescriptions for their patients who receive treatment at specialty institutions.

Significant Issues

Under the present system, either the UNM hospital incurs the costs for providing medications to these patients or patients who can not afford to pay full price for prescriptions do not receive needed medication. Both outcomes are undesirable. It is possible the solution to this problem will involve either a change in federal regulation or a waiver or by regulatory requirements of the State Board of Pharmacy. Representatives from the federal Health Care Financing Authority (HCFA) and the Board of Pharmacy need to be included in the study group.

RELATIONSHIP

Relates to:

SB 140, Indian Prescription Drug Purchase

SB 141, Prescription Drug Fair Pricing Act

SB 142, NM Prescription Drug Discount Act

SB 143, Prescription Drug Senior Program

SB 144, Prescription Drug Bulk Purchasing

HJM 21, Affordable Drug Program Options for Seniors

HJM 22, Study Rising Costs of Prescription Drugs

HB 297, NM Prescription Drug Discount Act

HB 298, Native American Prescription Drug Program

HB 300, Special Prescription Drug Program for Seniors

HB 301, Prescription Drug Fair Pricing Act

HB 302, Prescription Drug Benefit for Seniors

SUBSTANTIVE ISSUES

• Uninsured people pay the highest cost for drugs. Studies have shown that people are less likely to buy necessary prescription drugs if their priorities are to buy food, and take care of their household and family. Seniors, the disabled, and others may have a difficult time traveling great distance for health care, and will do without. Community Health Centers were established to fulfill a need for people that otherwise would have no health care access.

• Hospitals, HMOs, insurance companies, government agencies and mail order companies are able to pay significantly lower prices than the drug stores from which millions of Americans buy their medications. Different government agencies (Medicaid, Medicare, Veterans Administration, Department of Defense) are charged widely different prices for the same drug.



• Retail prices vary for medication depending on source. Without insurance, the average cost of Methotrexate, to treat Rheumatoid Arthritis, Psoriasis, and Inflammatory Bowel Disease can cost $47.84; Coumadin, to treat cardiac conditions, can cost $20.91. (Sanders)



• The National Association of Community Health Centers, Inc. reports that Community Health Clinics provide access to health care for thousands of people who have been locked out of the "traditional" health care system.



• Health center services are not free, and charge on a sliding fee scale according to income.



• FQHCs are located in medically underserved areas and are eligible to receive cost based reimbursement rates for Medicaid and Medicare.

• FQHCs in New Mexico are located in rural areas. People travel from surrounding, often isolated, areas to receive treatment at the clinics. Traveling an additional 60-500 miles to get specialty care or prescription medication creates a bigger hardship for people who may be ill, have no private transportation of their own, or are disabled.

• University of New Mexico Hospital treats low income, uninsured people who live within and outside Bernalillo County.



• The Primary Care Association is a strong advocate for community health clinics, and understands the economic, social, cultural and other issues that the clinics face.



• The New Mexico Hospital Association is a strong advocate for hospitals, and understands that similar issues face many rural hospitals.
• The collaborative committee will need to establish a methodology on how this Joint Memorial will be done.

DW/ar