What’s driving the surge in state contract pharmacy protection laws—and how does a 340B-related bill actually become a law? In Episode 14 of 340Banter, co-hosts Chelsea Violette and Logan Yoho break it all down with clarity, insight, and real-world relevance.
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On today's episode of 340 Banter, Logan and I chat about the rise in contract
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pharmacy protection laws that we've seen over the last year,
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and specifically dive into the process of a bill becoming a law.
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Music.
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So this year has been a big year for state laws protecting against contract
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pharmacy restrictions, manufacturer actions.
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I have learned so much from you in the last couple of months just talking about
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the process of, you know, the introduction of a bill,
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how that moves through to actually become a law, and then the differences amongst the states.
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And I think that would be a great thing for us to focus on today because that's
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not an area that I've really delved into in the past.
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And as our expert on manufacturer restrictions, you're kind of having to do it
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by. I've had to learn while we go. Yes.
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So I think a good place to start is really talking about what that bill process looks like.
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And it's very similar to what we'd see in the federal landscape.
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But in most states, what we'd see is that a bill is going to be introduced and
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it can be introduced in the House or the Senate.
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Sometimes those are called different things in the States.
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And some states call their version of the House the Assembly or the House of
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Delegates. So it really looks different.
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I know sometimes it's caught me off guard when you say, like, it goes through both houses.
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And I'm like, well, one's a House, one's a Senate. And I know now that like
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those that's how you refer to it, but that catches me sometimes too.
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Another term you'll see is cameral, and that means it's a chamber.
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So there's two chambers in most of our states. We do have one that's a little odd.
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Nebraska only has one legislative chamber.
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What are they, is it the Senate? Is it the House? What do they call it?
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That I'm not sure of. Okay.
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It might just be called the legislature, but they only have the one.
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So, most everyone else has five representatives.
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Because you have one congressman, two senators.
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A state representative and a state senator, or some variation in terms.
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But basically, in either chamber, a legislator can introduce a bill.
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Once that bill gets introduced, it's referred to a committee.
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So that really looks different depending on what that bill looks like and where
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they think that that fits best.
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So all the states have the same committees? No, they're very different.
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And they can even differ from legislative session to legislative session.
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Some of that's left up to the leadership in the legislature.
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So I know Ohio previously only had a health committee.
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Now they've got two committees that focus on health issues. So they focus on
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different sides of health. Gotcha.
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But once that bill is introduced, it goes to the committee.
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So that's where it will get hearings. And those hearings can be from the legislators
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that are sponsoring or supporting the bill, but it can also be from the public.
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So we've seen here recently a lot of health centers and other covered entities
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going to the state legislators and test legislation.
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There's a lot of words there. I know. I'm sorry. To the legislatures and testifying for bills.
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So who are they testifying in front of?
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That's a great question. Because you're not, it's really intimidating,
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and you're not speaking to the entire legislature at once. You're going to speak to the committee.
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So generally, you're going to speak to five people, maybe 10,
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but it's a pretty small number.
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There'll be people coming in and out. That's a little new if you're not used
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to it, because they have different committees they're on and they're going to
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vote and they're coming back.
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So they may get up and down and it takes a little bit of getting used to.
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Are they consistently like the same positions in government that that would
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be in that group that you'd be testifying to?
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Or is it, again, kind of dependent on the topic in the state?
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I think it's dependent on how the committee's set up.
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So the different states can set it up differently. And most of the time,
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the leadership in both parties will pick who they want on a committee,
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much like our Congress does.
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So once you get through a committee, the committee has to vote to adopt
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it and to move it forward, or to just not move the bill out of committee.
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If it gets that favorable vote in the committee, then it can move on to that full chamber.
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So that looks like the House or the Senate.
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So that first vote isn't what gets it to the House or the Senate for,
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you know, for approval. That's just to actually get it in front of you.
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To get a vote. Okay. That moves it forward to a vote.
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So then, say it moves to your House and you get a vote in the positive.
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Then it's going to flip to the other chamber, and you're going to go through
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the same process. It's going to go to a committee.
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It may be a different committee than it was in the House.
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A bill I worked on previously, it was House health, but then when it flipped
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to the Senate, it went to Senate finance.
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So sometimes that doesn't make sense, but it's going to get assigned to a committee.
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It's going to go through that, look for that favorable vote in the committee,
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and then move to that chamber.
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Does it get amended often when it goes to the second committee? It can.
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Okay. So any bill that gets amended by the second chamber then has to go to
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what they call a conference committee.
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And that has members from both chambers, they get together and they talk through
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the bill and they come to a consensus.
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And then once either the bill passes, as it was originally passed in the first
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chamber, or you get through conference committee, it can go to the governor.
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That's where some different things can happen. Depends on your state.
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So at this point, it's been passed by both the House and the Senate or was it
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Nebraska's single legislature?
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Yep. And then it goes, like Congress, it has to go to the executive to sign it into law.
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So, in any state, the governor can sign it to make it law, or they can veto it
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and send it back to the legislature.
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And then there's a process to override a veto that can differ by this state.
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Then the other option, and this isn't available in all states,
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there's some states that if the governor doesn't act, doesn't sign the bill,
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it just becomes law anyway.
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And we've actually seen that with a contract pharmacy bill.
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Can't remember which one, but one of those went into effect without any action
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from the governor. Interesting.
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So that's the basic way that a bill becomes a law. Yeah.
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There are nuances depending on where you're at, and these states like to be
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a little different in the way they do things.
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So talk to me about what some of those variances are.
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Obviously, you can't kind of rattle off what each state requires,
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but being kind of walking through here, the different areas that that might differ by state. Yeah.
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Something interesting that doesn't happen in the federal landscape is that in
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15 states, we have term limits on our state legislature.
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Only 15 of them? Yeah, there's only 15.
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But, for example, I'm really well-versed in Ohio legislature and their general
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assembly, and that's what we call our legislature in Ohio. And that's where
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you've been most involved. involved.
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Yes, I've worked the most in Ohio, lived there all my life, but we are one of
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those 15 states that do have term limits.
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So we have a limit of eight years in each chamber.
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So there are four-year terms in the Senate, so you can serve two of those,
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plus you can serve four two-year terms in the House.
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Why can't they make them all the same length?
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That is a great question. I know Sorry, I didn't mean to whisper that,
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but it just seems silly to me to have different term lengths for the different chambers.
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I think the reason the different term lengths are is that generally your house,
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and this goes for Congress as well, the House of Representatives tends to be
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the closer to the people.
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That makes sense. It's sometimes Congress is a lot of times the House of Representatives.
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It's called the people's house.
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So your representatives tend to be a little bolder. They don't follow quite
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the norms that you see in the Senate.
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The Senate is a little more longstanding.
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There's a different air of camaraderie.
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They work across the aisle a little bit more in the Senate and the longer terms
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because they serve a bigger portion of the state.
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And they've had longer to build those relationships, working relationships.
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Okay, that makes sense. Yep. So it's just a that follows federal.
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But I know what the term limits only have in 15 states seems weird.
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A lot of people would love term limits on the federal legislature,
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but that hasn't happened as of yet. Yeah.
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Do you happen to know just out of the top of your head, like what the longest
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serving term is right now? Like who's in Congress?
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In Congress, I was just thinking amongst the states, like who's in states where
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there's not term limits.
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I believe there are congressional members that have served over three decades at this point.
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So close to the age I am and not quite as old as me.
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But it's kind of crazy when you do have states that have term limits.
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So and we have term limits on the president.
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And not every state has that on the governor as well. So that can differ by
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state. Another difference is, and it's kind of hard for people to understand,
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especially with all these contract pharmacy protection laws going into effect.
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Once we pass them, we want them, we want that action.
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We've worked so hard to get them passed. So when is it going to help?
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And that's the bill effective date. That has been probably the most challenging
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for me to grasp and kind of delving into each state's policy here because I'm trying to figure out,
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you know, when the manufacturers do acknowledge that effective or that law.
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Is it as of the effective date of the law? Is it an arbitrary date that the
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manufacturer is picking?
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Just trying to kind of validate for our clients and make sure that we have all the information.
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And you also want to know when the law is actually in effect in case we want
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to pursue any enforcement. If we want to go to whoever the enforcement mechanism
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is and ask them to enforce a non-compliant manufacturer.
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So it is important.
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However, it's really hard. This is something I learn every day going through
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this because the different states are very, very different in how bills go into effect.
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So some recent examples that we've seen with contract pharmacy restrictions,
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New Mexico, it goes into effect in January.
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So they really only, their laws go into effect the January, and I believe we
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looked up that it's even numbered years, that when those go into effect,
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which is, that's a really long time.
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Yeah, especially if you make, you know, you pass a law early in an even numbered
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year and you have to wait, you know, almost two full years for that to then go into effect.
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So we're seeing like this, we're going to have to wait seven, eight months to see.
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And New Mexico is interesting because it only is targeted to health centers
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and health center lookalikes.
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So I know for myself, I'm really curious how the manufacturers are going to
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react to that. And we got to wait a while to see.
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Nebraska, we talked about them earlier being unicameral They did something interesting
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that's not always done And they added an emergency clause to their.
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So normally, they would have a waiting period for their bill to go active.
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But in most states, you can add an emergency clause, and it allows that bill
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to go into effect as soon as it's signed.
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So that was great for the Nebraska-covered entities, because they don't have
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to wait three, four, six months for a bill to go into effect.
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And the other one we've seen recently would be North Dakota.
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And all of their bills that are passed during the legislative session go,
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with the exception of like fiscal bills, go into effect on August 1st.
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So they just have a set date.
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Do the variances, are they kind of tied to the differences in the legislative
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sessions amongst the states? Because not every state has the same legislative session calendar.
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So is that kind of what it's tied to? I think that's part of it.
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There's a lot of states that only meet for a short time, maybe a year or a short
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time every two years even.
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So I think that's a lot of it, that they have set dates.
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Like in Ohio, we don't have set dates because we have a full-time legislature.
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So any point in the two-year General Assembly, a bill can be introduced or passed.
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And that is not the case in every state.
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So I think that that's why ours is more set on a number of days after it's signed
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as to when it would go into effect.
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Another question I'm thinking of kind of related to Kansas' contract pharmacy
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law is, you know, that law was passed with kind of a two-year clock on it.
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Is it standard for laws to have, you know, for laws like these contract pharmacy
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laws to have a timeline or a time limit clock placed on them?
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Or is that kind of uniquely written into, you know, a specific law?
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I haven't seen that often. I think that the reason Kansas had that situation
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come up is it was tied to the budget.
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And the budget is a two-year fiscal budget for the state.
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So that's why there was a clock on it. And generally, there wouldn't be.
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We have seen in some states, it can be tied to the budget and be permanent,
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but it really depends on the way the state does their budget and how it's written.
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So there have been talk in states like Ohio to add it to the budget and that
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it would be a permanent law.
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So it doesn't have to be, but I think that's why it was in a unique situation. And so,
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Another state that just passed that we've seen something interesting from is Tennessee.
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And it's unique because it's only for new contract pharmacy restrictions.
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So I don't know if you've seen if we've had any states or any manufacturers
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announce any compliance with that law yet, but it'll be interesting to watch.
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We've not had any new manufacturers announce restrictive policies since Tennessee's
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law was passed. I believe that is effective July 1st.
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So anything that the law is effective, excuse me, July 1st. And at the point
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of recording, we're not there yet.
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And the effective date for the restrictions that it would apply to would be
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anything that that occurs after July 1st.
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And, you know, until we see new manufacturers with restrictions after that date, or,
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you know, the one that I'm less clear on is if an existing manufacturer chooses
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to change or impose a different restriction if that's, you know,
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prevented or covered under the law as well.
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So in that case, it would be like a manufacturer that currently allows a designation.
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But if they add data submission requirements to that designation,
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does that violate the law?
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And I'm not clear on that. And I don't think anyone I've talked to is really
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clear on it because it is such a unique bill that we haven't seen yet.
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And I think that that's a really great point about why the state work is so
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important is because you can keep, it's such a small number of people that can make an impact.
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And the state legislature is so well connected with the constituency that you
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can make a lot of change really fast.
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So it's important that you remain engaged, even if you're not following it as closely as I might.
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It's important that you know what is going on so you can avoid any,
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because things can happen so fast, you could get something you don't want to see happen really fast.
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And we've seen some troubling stuff with some states wanting to impose restrictions on covered entities.
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So we're keeping really close eye on that.
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The transparency laws, we're all for transparency, but we want it to be done correctly.
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So those are something you just definitely want to keep an eye on.
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Not all state laws are going to be in your favor. So just remaining vigilant
00:18:09.560 --> 00:18:11.900
and following resources on.
00:18:12.536 --> 00:18:18.976
On from your state PCA or your health, your hospital association are great resources.
00:18:19.256 --> 00:18:23.516
So I know sometimes at the federal level, things will get tacked on to a,
00:18:23.516 --> 00:18:27.536
you know, a bill or a law right before it gets signed last minute.
00:18:27.696 --> 00:18:31.836
You know, there are a lot of last minute changes. Do we see similar last minute
00:18:31.836 --> 00:18:36.916
changes to laws at the state level as well? Things kind of get snuck in at the last minute?
00:18:37.236 --> 00:18:41.396
Yeah, it's it is possible depending on how the state operates.
00:18:41.396 --> 00:18:44.736
It's definitely possible to see those last-minute add-ons.
00:18:44.916 --> 00:18:50.076
I think it's probably less so at the state level because there's so many bills that go through.
00:18:50.416 --> 00:18:55.696
In Congress, there's a very small amount of bills that actually progress through the process.
00:18:55.876 --> 00:18:59.396
But at the state level, you'll see a lot more bills go through,
00:18:59.456 --> 00:19:05.456
and you'll see a lot more what I refer to as clean bills that don't have...
00:19:05.456 --> 00:19:09.536
They're not being used as vehicles for other things? Yeah, that's a whole lot
00:19:09.536 --> 00:19:11.356
less likely at the state levels.
00:19:11.736 --> 00:19:17.456
And something interesting that does happen in some states is that the governor
00:19:17.456 --> 00:19:19.816
may also have line item veto power.
00:19:20.096 --> 00:19:25.496
So that is not allowed at the federal level. The Supreme Court has ruled that
00:19:25.496 --> 00:19:27.596
the president doesn't have that ability.
00:19:27.976 --> 00:19:36.476
In some states, the governor can veto a specific line in a bill instead of vetoing the whole bill.
00:19:36.976 --> 00:19:40.296
And they would make the decision then to just pass the rest of it.
00:19:40.376 --> 00:19:44.356
That doesn't get bumped back down to House and Senate for approval?
00:19:44.356 --> 00:19:48.716
And the states that allow that, everything but that line passes,
00:19:49.076 --> 00:19:53.376
which can create a lot of the devil is in the details of how these bills are written.
00:19:53.876 --> 00:20:00.356
If you change even just take out three words in a bill, it could change the whole meaning.
00:20:00.576 --> 00:20:04.696
So it's really important that you have that education period.
00:20:05.136 --> 00:20:09.776
And when we're working on a bill, a lot of times we think about the legislature.
00:20:09.776 --> 00:20:14.596
It's sometimes good to, depending on your state, to loop in the governor's office
00:20:14.596 --> 00:20:18.596
as well on what your priorities are and why it's so important.
00:20:18.876 --> 00:20:21.056
So around kind of that point.
00:20:21.664 --> 00:20:24.864
I think it was almost a year ago at this point.
00:20:25.004 --> 00:20:28.624
Was it Virginia's contract pharmacy bill that had made it all the way through
00:20:28.624 --> 00:20:33.224
and then the governor vetoed it at the last minute? I think that's the only
00:20:33.224 --> 00:20:34.424
one we've seen that happen with.
00:20:34.864 --> 00:20:39.204
Yeah, I believe so. We've seen governors not sign bills and they go into effect.
00:20:39.204 --> 00:20:43.324
But I think Virginia was the only one we've seen that's been vetoed.
00:20:43.444 --> 00:20:44.764
And Virginia was kind of weird.
00:20:44.904 --> 00:20:47.204
And I'm trying to remember off the top of my head some of the details.
00:20:47.204 --> 00:20:48.104
Sorry for putting you on the spot. Yes.
00:20:48.364 --> 00:20:53.324
But Virginia had some interesting, I wanted to say it was a temporary bill anyway,
00:20:53.324 --> 00:20:56.284
so it was going to be a little unique. More like Kansas?
00:20:56.664 --> 00:21:00.464
Yeah. Okay. But I don't remember off the top of my head. So if a governor does
00:21:00.464 --> 00:21:03.764
veto a bill, is it automatically dead in the water?
00:21:03.964 --> 00:21:08.604
Does it go back down through the original committee or does it go just down
00:21:08.604 --> 00:21:09.504
to the second committee?
00:21:09.604 --> 00:21:12.624
Where does it fall back if the governor does veto it? When it goes back,
00:21:12.984 --> 00:21:14.884
it's not dead in the water necessarily.
00:21:15.204 --> 00:21:21.284
When it goes back, it goes back to the leadership of whichever chamber started the bill.
00:21:21.624 --> 00:21:26.124
So when you get assigned a bill number, in most states, it's going to be House
00:21:26.124 --> 00:21:31.064
Bill blah, blah, blah, or HB. or SB.
00:21:31.424 --> 00:21:38.104
So when you go to do a veto override, if that's the desire of the legislature,
00:21:38.304 --> 00:21:42.804
it would go back, if it was a House bill, it would go to House leadership to
00:21:42.804 --> 00:21:44.664
bring to the floor for a vote.
00:21:45.324 --> 00:21:52.104
And vetoes are tricky things, and there's a lot of political discussion there.
00:21:52.104 --> 00:21:56.784
And when the legislature's deciding what is worth overriding a veto,
00:21:56.784 --> 00:22:00.244
So because... Is it worth spending the political capital on?
00:22:00.384 --> 00:22:05.224
That's it. Yeah. You don't want to upset the governor if you are going to lose out later.
00:22:05.524 --> 00:22:11.724
So it's sometimes a tricky dance on what the optics look like.
00:22:11.944 --> 00:22:15.004
Well, this has been super helpful, Logan. Thank you so much. Thank you.
"I think the reason the different term lengths exist is that, generally, the House—and this goes for Congress as well—the House of Representatives tends to be closer to the people. Sometimes Congress, or at least the House, is even called the “people’s house.” So your representatives tend to be a little bolder. They don’t always follow the same norms that you see in the Senate. The Senate is a little more longstanding, with a different air of camaraderie. Senators tend to work across the aisle a bit more, and because they serve longer terms and represent a larger portion of the state, they’ve had more time to build those working relationships."
Meet Logan Yoho, PharmD, BCACP, 340B ACE, and co-host of the 340Banter Podcast. With nearly a decade of experience in the 340B industry, Logan is dedicated to helping health centers optimize and maintain successful, compliant 340B Programs. As Director of Advocacy and Education at FQHC 340B Compliance, he focuses on implementing entity-owned pharmacies and guiding advocacy efforts for 340B. Logan’s extensive background includes leading the pharmacy and 340B programs at Hopewell Health Centers, serving as Apexus 340B University Faculty, and chairing the Ohio 340B FQHC Consortium. Logan’s leadership and expertise have earned him multiple awards, and he brings a wealth of knowledge to every episode of 340Banter.
Meet Chelsea Violette, PharmD, BCACP, 340B ACE, and your co-host for the 340Banter Podcast. With over a decade of experience in pharmacy and 340B Program management, Chelsea brings a wealth of knowledge to the table. As Chief Operating Officer at FQHC 340B Compliance, she works tirelessly to support health centers across the country, ensuring they have the tools and strategies they need to succeed. Chelsea’s hands-on experience as a 340B Consultant and Pharmacy Manager, combined with her expertise as a subject matter expert for the Apexus 340B Prime Vendor Program, makes her a trusted voice in the world of 340B compliance. Tune in for her practical insights, guidance, and lively discussions on all things 340B.
00:00:00.017 --> 00:00:05.137
On today's episode of 340 Banter, Logan and I chat about the rise in contract
00:00:05.137 --> 00:00:08.157
pharmacy protection laws that we've seen over the last year,
00:00:08.357 --> 00:00:12.037
and specifically dive into the process of a bill becoming a law.
00:00:14.000 --> 00:00:32.400
Music.
00:00:31.937 --> 00:00:37.697
So this year has been a big year for state laws protecting against contract
00:00:37.697 --> 00:00:39.937
pharmacy restrictions, manufacturer actions.
00:00:40.217 --> 00:00:45.937
I have learned so much from you in the last couple of months just talking about
00:00:45.937 --> 00:00:50.677
the process of, you know, the introduction of a bill,
00:00:50.977 --> 00:00:55.397
how that moves through to actually become a law, and then the differences amongst the states.
00:00:55.397 --> 00:00:59.137
And I think that would be a great thing for us to focus on today because that's
00:00:59.137 --> 00:01:02.077
not an area that I've really delved into in the past.
00:01:02.317 --> 00:01:06.457
And as our expert on manufacturer restrictions, you're kind of having to do it
00:01:06.457 --> 00:01:09.057
by. I've had to learn while we go. Yes.
00:01:09.757 --> 00:01:14.937
So I think a good place to start is really talking about what that bill process looks like.
00:01:15.077 --> 00:01:20.137
And it's very similar to what we'd see in the federal landscape.
00:01:20.137 --> 00:01:25.137
But in most states, what we'd see is that a bill is going to be introduced and
00:01:25.137 --> 00:01:28.177
it can be introduced in the House or the Senate.
00:01:28.457 --> 00:01:30.637
Sometimes those are called different things in the States.
00:01:31.017 --> 00:01:36.977
And some states call their version of the House the Assembly or the House of
00:01:36.977 --> 00:01:39.357
Delegates. So it really looks different.
00:01:39.557 --> 00:01:43.397
I know sometimes it's caught me off guard when you say, like, it goes through both houses.
00:01:43.557 --> 00:01:47.157
And I'm like, well, one's a House, one's a Senate. And I know now that like
00:01:47.157 --> 00:01:50.577
those that's how you refer to it, but that catches me sometimes too.
00:01:50.837 --> 00:01:55.497
Another term you'll see is cameral, and that means it's a chamber.
00:01:56.017 --> 00:02:01.457
So there's two chambers in most of our states. We do have one that's a little odd.
00:02:01.697 --> 00:02:04.537
Nebraska only has one legislative chamber.
00:02:05.017 --> 00:02:07.937
What are they, is it the Senate? Is it the House? What do they call it?
00:02:07.937 --> 00:02:09.097
That I'm not sure of. Okay.
00:02:09.317 --> 00:02:15.077
It might just be called the legislature, but they only have the one.
00:02:15.077 --> 00:02:20.077
So, most everyone else has five representatives.
00:02:20.457 --> 00:02:23.897
Because you have one congressman, two senators.
00:02:24.660 --> 00:02:29.960
A state representative and a state senator, or some variation in terms.
00:02:30.200 --> 00:02:38.320
But basically, in either chamber, a legislator can introduce a bill.
00:02:38.620 --> 00:02:41.740
Once that bill gets introduced, it's referred to a committee.
00:02:41.940 --> 00:02:46.500
So that really looks different depending on what that bill looks like and where
00:02:46.500 --> 00:02:48.560
they think that that fits best.
00:02:48.900 --> 00:02:52.300
So all the states have the same committees? No, they're very different.
00:02:52.300 --> 00:02:56.980
And they can even differ from legislative session to legislative session.
00:02:57.220 --> 00:03:03.080
Some of that's left up to the leadership in the legislature.
00:03:03.500 --> 00:03:07.520
So I know Ohio previously only had a health committee.
00:03:07.720 --> 00:03:12.900
Now they've got two committees that focus on health issues. So they focus on
00:03:12.900 --> 00:03:14.680
different sides of health. Gotcha.
00:03:15.180 --> 00:03:18.560
But once that bill is introduced, it goes to the committee.
00:03:18.680 --> 00:03:25.680
So that's where it will get hearings. And those hearings can be from the legislators
00:03:25.680 --> 00:03:30.420
that are sponsoring or supporting the bill, but it can also be from the public.
00:03:30.700 --> 00:03:34.820
So we've seen here recently a lot of health centers and other covered entities
00:03:34.820 --> 00:03:38.200
going to the state legislators and test legislation.
00:03:39.881 --> 00:03:46.241
There's a lot of words there. I know. I'm sorry. To the legislatures and testifying for bills.
00:03:46.401 --> 00:03:48.841
So who are they testifying in front of?
00:03:49.061 --> 00:03:53.241
That's a great question. Because you're not, it's really intimidating,
00:03:53.241 --> 00:03:59.221
and you're not speaking to the entire legislature at once. You're going to speak to the committee.
00:03:59.441 --> 00:04:03.821
So generally, you're going to speak to five people, maybe 10,
00:04:04.121 --> 00:04:06.581
but it's a pretty small number.
00:04:06.821 --> 00:04:10.821
There'll be people coming in and out. That's a little new if you're not used
00:04:10.821 --> 00:04:13.941
to it, because they have different committees they're on and they're going to
00:04:13.941 --> 00:04:15.321
vote and they're coming back.
00:04:15.721 --> 00:04:20.681
So they may get up and down and it takes a little bit of getting used to.
00:04:20.901 --> 00:04:24.781
Are they consistently like the same positions in government that that would
00:04:24.781 --> 00:04:27.081
be in that group that you'd be testifying to?
00:04:27.181 --> 00:04:30.501
Or is it, again, kind of dependent on the topic in the state?
00:04:30.501 --> 00:04:33.541
I think it's dependent on how the committee's set up.
00:04:33.821 --> 00:04:38.361
So the different states can set it up differently. And most of the time,
00:04:38.461 --> 00:04:44.041
the leadership in both parties will pick who they want on a committee,
00:04:44.341 --> 00:04:45.941
much like our Congress does.
00:04:45.941 --> 00:04:51.441
So once you get through a committee, the committee has to vote to adopt
00:04:51.441 --> 00:04:57.381
it and to move it forward, or to just not move the bill out of committee.
00:04:57.601 --> 00:05:03.121
If it gets that favorable vote in the committee, then it can move on to that full chamber.
00:05:03.381 --> 00:05:06.341
So that looks like the House or the Senate.
00:05:06.661 --> 00:05:11.961
So that first vote isn't what gets it to the House or the Senate for,
00:05:12.101 --> 00:05:16.101
you know, for approval. That's just to actually get it in front of you.
00:05:16.101 --> 00:05:18.761
To get a vote. Okay. That moves it forward to a vote.
00:05:19.181 --> 00:05:25.261
So then, say it moves to your House and you get a vote in the positive.
00:05:25.921 --> 00:05:30.101
Then it's going to flip to the other chamber, and you're going to go through
00:05:30.101 --> 00:05:32.221
the same process. It's going to go to a committee.
00:05:32.581 --> 00:05:35.981
It may be a different committee than it was in the House.
00:05:36.939 --> 00:05:41.359
A bill I worked on previously, it was House health, but then when it flipped
00:05:41.359 --> 00:05:42.959
to the Senate, it went to Senate finance.
00:05:43.799 --> 00:05:48.179
So sometimes that doesn't make sense, but it's going to get assigned to a committee.
00:05:48.279 --> 00:05:52.079
It's going to go through that, look for that favorable vote in the committee,
00:05:52.079 --> 00:05:53.459
and then move to that chamber.
00:05:53.959 --> 00:05:58.479
Does it get amended often when it goes to the second committee? It can.
00:05:58.779 --> 00:06:05.119
Okay. So any bill that gets amended by the second chamber then has to go to
00:06:05.119 --> 00:06:06.619
what they call a conference committee.
00:06:06.939 --> 00:06:12.179
And that has members from both chambers, they get together and they talk through
00:06:12.179 --> 00:06:13.999
the bill and they come to a consensus.
00:06:14.419 --> 00:06:19.219
And then once either the bill passes, as it was originally passed in the first
00:06:19.219 --> 00:06:23.299
chamber, or you get through conference committee, it can go to the governor.
00:06:24.019 --> 00:06:27.259
That's where some different things can happen. Depends on your state.
00:06:27.619 --> 00:06:33.219
So at this point, it's been passed by both the House and the Senate or was it
00:06:33.219 --> 00:06:35.979
Nebraska's single legislature?
00:06:36.959 --> 00:06:43.439
Yep. And then it goes, like Congress, it has to go to the executive to sign it into law.
00:06:43.919 --> 00:06:51.599
So, in any state, the governor can sign it to make it law, or they can veto it
00:06:51.599 --> 00:06:52.919
and send it back to the legislature.
00:06:53.159 --> 00:06:57.319
And then there's a process to override a veto that can differ by this state.
00:06:57.319 --> 00:07:01.399
Then the other option, and this isn't available in all states,
00:07:01.579 --> 00:07:05.119
there's some states that if the governor doesn't act, doesn't sign the bill,
00:07:05.259 --> 00:07:06.859
it just becomes law anyway.
00:07:07.059 --> 00:07:10.079
And we've actually seen that with a contract pharmacy bill.
00:07:10.299 --> 00:07:15.379
Can't remember which one, but one of those went into effect without any action
00:07:15.379 --> 00:07:17.179
from the governor. Interesting.
00:07:17.579 --> 00:07:22.999
So that's the basic way that a bill becomes a law. Yeah.
00:07:23.526 --> 00:07:28.226
There are nuances depending on where you're at, and these states like to be
00:07:28.226 --> 00:07:30.166
a little different in the way they do things.
00:07:30.346 --> 00:07:33.986
So talk to me about what some of those variances are.
00:07:34.106 --> 00:07:37.966
Obviously, you can't kind of rattle off what each state requires,
00:07:38.186 --> 00:07:44.386
but being kind of walking through here, the different areas that that might differ by state. Yeah.
00:07:44.726 --> 00:07:50.266
Something interesting that doesn't happen in the federal landscape is that in
00:07:50.266 --> 00:07:54.066
15 states, we have term limits on our state legislature.
00:07:54.366 --> 00:07:56.706
Only 15 of them? Yeah, there's only 15.
00:07:57.146 --> 00:08:02.566
But, for example, I'm really well-versed in Ohio legislature and their general
00:08:02.566 --> 00:08:06.026
assembly, and that's what we call our legislature in Ohio. And that's where
00:08:06.026 --> 00:08:07.326
you've been most involved. involved.
00:08:07.626 --> 00:08:12.446
Yes, I've worked the most in Ohio, lived there all my life, but we are one of
00:08:12.446 --> 00:08:14.566
those 15 states that do have term limits.
00:08:14.866 --> 00:08:19.526
So we have a limit of eight years in each chamber.
00:08:19.546 --> 00:08:23.266
So there are four-year terms in the Senate, so you can serve two of those,
00:08:23.306 --> 00:08:26.966
plus you can serve four two-year terms in the House.
00:08:27.206 --> 00:08:29.586
Why can't they make them all the same length?
00:08:30.346 --> 00:08:34.806
That is a great question. I know Sorry, I didn't mean to whisper that,
00:08:34.946 --> 00:08:40.486
but it just seems silly to me to have different term lengths for the different chambers.
00:08:40.786 --> 00:08:47.506
I think the reason the different term lengths are is that generally your house,
00:08:47.506 --> 00:08:52.126
and this goes for Congress as well, the House of Representatives tends to be
00:08:52.126 --> 00:08:53.966
the closer to the people.
00:08:54.426 --> 00:08:59.166
That makes sense. It's sometimes Congress is a lot of times the House of Representatives.
00:08:59.426 --> 00:09:00.686
It's called the people's house.
00:09:01.486 --> 00:09:07.586
So your representatives tend to be a little bolder. They don't follow quite
00:09:07.586 --> 00:09:09.406
the norms that you see in the Senate.
00:09:09.666 --> 00:09:11.726
The Senate is a little more longstanding.
00:09:12.426 --> 00:09:16.786
There's a different air of camaraderie.
00:09:17.066 --> 00:09:21.686
They work across the aisle a little bit more in the Senate and the longer terms
00:09:21.686 --> 00:09:24.426
because they serve a bigger portion of the state.
00:09:24.766 --> 00:09:29.006
And they've had longer to build those relationships, working relationships.
00:09:29.266 --> 00:09:33.746
Okay, that makes sense. Yep. So it's just a that follows federal.
00:09:34.166 --> 00:09:38.266
But I know what the term limits only have in 15 states seems weird.
00:09:38.786 --> 00:09:42.026
A lot of people would love term limits on the federal legislature,
00:09:42.026 --> 00:09:44.546
but that hasn't happened as of yet. Yeah.
00:09:45.146 --> 00:09:48.286
Do you happen to know just out of the top of your head, like what the longest
00:09:48.286 --> 00:09:52.926
serving term is right now? Like who's in Congress?
00:09:54.278 --> 00:09:58.578
In Congress, I was just thinking amongst the states, like who's in states where
00:09:58.578 --> 00:09:59.158
there's not term limits.
00:09:59.318 --> 00:10:05.398
I believe there are congressional members that have served over three decades at this point.
00:10:05.618 --> 00:10:10.098
So close to the age I am and not quite as old as me.
00:10:10.298 --> 00:10:15.338
But it's kind of crazy when you do have states that have term limits.
00:10:15.518 --> 00:10:17.918
So and we have term limits on the president.
00:10:18.258 --> 00:10:22.438
And not every state has that on the governor as well. So that can differ by
00:10:22.438 --> 00:10:28.018
state. Another difference is, and it's kind of hard for people to understand,
00:10:28.158 --> 00:10:31.998
especially with all these contract pharmacy protection laws going into effect.
00:10:32.198 --> 00:10:35.858
Once we pass them, we want them, we want that action.
00:10:36.358 --> 00:10:40.218
We've worked so hard to get them passed. So when is it going to help?
00:10:40.418 --> 00:10:45.678
And that's the bill effective date. That has been probably the most challenging
00:10:45.678 --> 00:10:52.258
for me to grasp and kind of delving into each state's policy here because I'm trying to figure out,
00:10:52.398 --> 00:10:58.478
you know, when the manufacturers do acknowledge that effective or that law.
00:10:58.658 --> 00:11:02.698
Is it as of the effective date of the law? Is it an arbitrary date that the
00:11:02.698 --> 00:11:03.758
manufacturer is picking?
00:11:03.978 --> 00:11:09.438
Just trying to kind of validate for our clients and make sure that we have all the information.
00:11:09.438 --> 00:11:14.238
And you also want to know when the law is actually in effect in case we want
00:11:14.238 --> 00:11:19.778
to pursue any enforcement. If we want to go to whoever the enforcement mechanism
00:11:19.778 --> 00:11:24.118
is and ask them to enforce a non-compliant manufacturer.
00:11:24.458 --> 00:11:26.598
So it is important.
00:11:26.958 --> 00:11:33.578
However, it's really hard. This is something I learn every day going through
00:11:33.578 --> 00:11:38.598
this because the different states are very, very different in how bills go into effect.
00:11:38.878 --> 00:11:43.538
So some recent examples that we've seen with contract pharmacy restrictions,
00:11:43.978 --> 00:11:47.418
New Mexico, it goes into effect in January.
00:11:48.158 --> 00:11:54.638
So they really only, their laws go into effect the January, and I believe we
00:11:54.638 --> 00:11:58.958
looked up that it's even numbered years, that when those go into effect,
00:11:59.118 --> 00:12:01.638
which is, that's a really long time.
00:12:01.958 --> 00:12:08.118
Yeah, especially if you make, you know, you pass a law early in an even numbered
00:12:08.118 --> 00:12:12.118
year and you have to wait, you know, almost two full years for that to then go into effect.
00:12:12.118 --> 00:12:18.338
So we're seeing like this, we're going to have to wait seven, eight months to see.
00:12:18.518 --> 00:12:24.618
And New Mexico is interesting because it only is targeted to health centers
00:12:24.618 --> 00:12:25.878
and health center lookalikes.
00:12:26.138 --> 00:12:31.378
So I know for myself, I'm really curious how the manufacturers are going to
00:12:31.378 --> 00:12:34.298
react to that. And we got to wait a while to see.
00:12:35.378 --> 00:12:42.798
Nebraska, we talked about them earlier being unicameral They did something interesting
00:12:42.798 --> 00:12:49.558
that's not always done And they added an emergency clause to their.
00:12:50.534 --> 00:12:54.534
So normally, they would have a waiting period for their bill to go active.
00:12:54.834 --> 00:13:00.614
But in most states, you can add an emergency clause, and it allows that bill
00:13:00.614 --> 00:13:02.594
to go into effect as soon as it's signed.
00:13:02.914 --> 00:13:08.134
So that was great for the Nebraska-covered entities, because they don't have
00:13:08.134 --> 00:13:13.054
to wait three, four, six months for a bill to go into effect.
00:13:13.314 --> 00:13:16.794
And the other one we've seen recently would be North Dakota.
00:13:16.794 --> 00:13:20.774
And all of their bills that are passed during the legislative session go,
00:13:20.994 --> 00:13:25.734
with the exception of like fiscal bills, go into effect on August 1st.
00:13:25.834 --> 00:13:27.134
So they just have a set date.
00:13:27.534 --> 00:13:34.754
Do the variances, are they kind of tied to the differences in the legislative
00:13:34.754 --> 00:13:41.974
sessions amongst the states? Because not every state has the same legislative session calendar.
00:13:42.214 --> 00:13:44.594
So is that kind of what it's tied to? I think that's part of it.
00:13:44.594 --> 00:13:51.934
There's a lot of states that only meet for a short time, maybe a year or a short
00:13:51.934 --> 00:13:53.834
time every two years even.
00:13:54.094 --> 00:13:57.474
So I think that's a lot of it, that they have set dates.
00:13:57.654 --> 00:14:02.254
Like in Ohio, we don't have set dates because we have a full-time legislature.
00:14:02.814 --> 00:14:08.354
So any point in the two-year General Assembly, a bill can be introduced or passed.
00:14:08.614 --> 00:14:11.534
And that is not the case in every state.
00:14:11.714 --> 00:14:16.954
So I think that that's why ours is more set on a number of days after it's signed
00:14:16.954 --> 00:14:19.454
as to when it would go into effect.
00:14:19.634 --> 00:14:25.134
Another question I'm thinking of kind of related to Kansas' contract pharmacy
00:14:25.134 --> 00:14:31.474
law is, you know, that law was passed with kind of a two-year clock on it.
00:14:32.354 --> 00:14:37.734
Is it standard for laws to have, you know, for laws like these contract pharmacy
00:14:37.734 --> 00:14:42.534
laws to have a timeline or a time limit clock placed on them?
00:14:42.534 --> 00:14:46.874
Or is that kind of uniquely written into, you know, a specific law?
00:14:46.874 --> 00:14:54.014
I haven't seen that often. I think that the reason Kansas had that situation
00:14:54.014 --> 00:14:56.754
come up is it was tied to the budget.
00:14:56.954 --> 00:15:00.934
And the budget is a two-year fiscal budget for the state.
00:15:01.054 --> 00:15:05.114
So that's why there was a clock on it. And generally, there wouldn't be.
00:15:05.834 --> 00:15:11.754
We have seen in some states, it can be tied to the budget and be permanent,
00:15:11.754 --> 00:15:15.834
but it really depends on the way the state does their budget and how it's written.
00:15:16.414 --> 00:15:22.534
So there have been talk in states like Ohio to add it to the budget and that
00:15:22.534 --> 00:15:23.654
it would be a permanent law.
00:15:23.814 --> 00:15:29.494
So it doesn't have to be, but I think that's why it was in a unique situation. And so,
00:15:30.000 --> 00:15:34.900
Another state that just passed that we've seen something interesting from is Tennessee.
00:15:35.480 --> 00:15:40.520
And it's unique because it's only for new contract pharmacy restrictions.
00:15:41.040 --> 00:15:47.300
So I don't know if you've seen if we've had any states or any manufacturers
00:15:47.300 --> 00:15:51.540
announce any compliance with that law yet, but it'll be interesting to watch.
00:15:51.700 --> 00:15:58.080
We've not had any new manufacturers announce restrictive policies since Tennessee's
00:15:58.080 --> 00:16:03.060
law was passed. I believe that is effective July 1st.
00:16:03.300 --> 00:16:08.760
So anything that the law is effective, excuse me, July 1st. And at the point
00:16:08.760 --> 00:16:10.140
of recording, we're not there yet.
00:16:10.520 --> 00:16:15.700
And the effective date for the restrictions that it would apply to would be
00:16:15.700 --> 00:16:18.620
anything that that occurs after July 1st.
00:16:18.620 --> 00:16:25.720
And, you know, until we see new manufacturers with restrictions after that date, or,
00:16:25.940 --> 00:16:33.000
you know, the one that I'm less clear on is if an existing manufacturer chooses
00:16:33.000 --> 00:16:37.980
to change or impose a different restriction if that's, you know,
00:16:38.100 --> 00:16:39.820
prevented or covered under the law as well.
00:16:39.820 --> 00:16:44.260
So in that case, it would be like a manufacturer that currently allows a designation.
00:16:44.260 --> 00:16:48.000
But if they add data submission requirements to that designation,
00:16:48.420 --> 00:16:50.460
does that violate the law?
00:16:51.340 --> 00:16:57.060
And I'm not clear on that. And I don't think anyone I've talked to is really
00:16:57.060 --> 00:17:02.000
clear on it because it is such a unique bill that we haven't seen yet.
00:17:02.140 --> 00:17:08.300
And I think that that's a really great point about why the state work is so
00:17:08.300 --> 00:17:14.740
important is because you can keep, it's such a small number of people that can make an impact.
00:17:14.740 --> 00:17:21.860
And the state legislature is so well connected with the constituency that you
00:17:21.860 --> 00:17:24.420
can make a lot of change really fast.
00:17:24.440 --> 00:17:30.600
So it's important that you remain engaged, even if you're not following it as closely as I might.
00:17:30.820 --> 00:17:35.640
It's important that you know what is going on so you can avoid any,
00:17:35.880 --> 00:17:41.560
because things can happen so fast, you could get something you don't want to see happen really fast.
00:17:41.560 --> 00:17:49.860
And we've seen some troubling stuff with some states wanting to impose restrictions on covered entities.
00:17:50.240 --> 00:17:53.300
So we're keeping really close eye on that.
00:17:53.540 --> 00:17:59.380
The transparency laws, we're all for transparency, but we want it to be done correctly.
00:18:00.140 --> 00:18:04.020
So those are something you just definitely want to keep an eye on.
00:18:04.300 --> 00:18:09.560
Not all state laws are going to be in your favor. So just remaining vigilant
00:18:09.560 --> 00:18:11.900
and following resources on.
00:18:12.536 --> 00:18:18.976
On from your state PCA or your health, your hospital association are great resources.
00:18:19.256 --> 00:18:23.516
So I know sometimes at the federal level, things will get tacked on to a,
00:18:23.516 --> 00:18:27.536
you know, a bill or a law right before it gets signed last minute.
00:18:27.696 --> 00:18:31.836
You know, there are a lot of last minute changes. Do we see similar last minute
00:18:31.836 --> 00:18:36.916
changes to laws at the state level as well? Things kind of get snuck in at the last minute?
00:18:37.236 --> 00:18:41.396
Yeah, it's it is possible depending on how the state operates.
00:18:41.396 --> 00:18:44.736
It's definitely possible to see those last-minute add-ons.
00:18:44.916 --> 00:18:50.076
I think it's probably less so at the state level because there's so many bills that go through.
00:18:50.416 --> 00:18:55.696
In Congress, there's a very small amount of bills that actually progress through the process.
00:18:55.876 --> 00:18:59.396
But at the state level, you'll see a lot more bills go through,
00:18:59.456 --> 00:19:05.456
and you'll see a lot more what I refer to as clean bills that don't have...
00:19:05.456 --> 00:19:09.536
They're not being used as vehicles for other things? Yeah, that's a whole lot
00:19:09.536 --> 00:19:11.356
less likely at the state levels.
00:19:11.736 --> 00:19:17.456
And something interesting that does happen in some states is that the governor
00:19:17.456 --> 00:19:19.816
may also have line item veto power.
00:19:20.096 --> 00:19:25.496
So that is not allowed at the federal level. The Supreme Court has ruled that
00:19:25.496 --> 00:19:27.596
the president doesn't have that ability.
00:19:27.976 --> 00:19:36.476
In some states, the governor can veto a specific line in a bill instead of vetoing the whole bill.
00:19:36.976 --> 00:19:40.296
And they would make the decision then to just pass the rest of it.
00:19:40.376 --> 00:19:44.356
That doesn't get bumped back down to House and Senate for approval?
00:19:44.356 --> 00:19:48.716
And the states that allow that, everything but that line passes,
00:19:49.076 --> 00:19:53.376
which can create a lot of the devil is in the details of how these bills are written.
00:19:53.876 --> 00:20:00.356
If you change even just take out three words in a bill, it could change the whole meaning.
00:20:00.576 --> 00:20:04.696
So it's really important that you have that education period.
00:20:05.136 --> 00:20:09.776
And when we're working on a bill, a lot of times we think about the legislature.
00:20:09.776 --> 00:20:14.596
It's sometimes good to, depending on your state, to loop in the governor's office
00:20:14.596 --> 00:20:18.596
as well on what your priorities are and why it's so important.
00:20:18.876 --> 00:20:21.056
So around kind of that point.
00:20:21.664 --> 00:20:24.864
I think it was almost a year ago at this point.
00:20:25.004 --> 00:20:28.624
Was it Virginia's contract pharmacy bill that had made it all the way through
00:20:28.624 --> 00:20:33.224
and then the governor vetoed it at the last minute? I think that's the only
00:20:33.224 --> 00:20:34.424
one we've seen that happen with.
00:20:34.864 --> 00:20:39.204
Yeah, I believe so. We've seen governors not sign bills and they go into effect.
00:20:39.204 --> 00:20:43.324
But I think Virginia was the only one we've seen that's been vetoed.
00:20:43.444 --> 00:20:44.764
And Virginia was kind of weird.
00:20:44.904 --> 00:20:47.204
And I'm trying to remember off the top of my head some of the details.
00:20:47.204 --> 00:20:48.104
Sorry for putting you on the spot. Yes.
00:20:48.364 --> 00:20:53.324
But Virginia had some interesting, I wanted to say it was a temporary bill anyway,
00:20:53.324 --> 00:20:56.284
so it was going to be a little unique. More like Kansas?
00:20:56.664 --> 00:21:00.464
Yeah. Okay. But I don't remember off the top of my head. So if a governor does
00:21:00.464 --> 00:21:03.764
veto a bill, is it automatically dead in the water?
00:21:03.964 --> 00:21:08.604
Does it go back down through the original committee or does it go just down
00:21:08.604 --> 00:21:09.504
to the second committee?
00:21:09.604 --> 00:21:12.624
Where does it fall back if the governor does veto it? When it goes back,
00:21:12.984 --> 00:21:14.884
it's not dead in the water necessarily.
00:21:15.204 --> 00:21:21.284
When it goes back, it goes back to the leadership of whichever chamber started the bill.
00:21:21.624 --> 00:21:26.124
So when you get assigned a bill number, in most states, it's going to be House
00:21:26.124 --> 00:21:31.064
Bill blah, blah, blah, or HB. or SB.
00:21:31.424 --> 00:21:38.104
So when you go to do a veto override, if that's the desire of the legislature,
00:21:38.304 --> 00:21:42.804
it would go back, if it was a House bill, it would go to House leadership to
00:21:42.804 --> 00:21:44.664
bring to the floor for a vote.
00:21:45.324 --> 00:21:52.104
And vetoes are tricky things, and there's a lot of political discussion there.
00:21:52.104 --> 00:21:56.784
And when the legislature's deciding what is worth overriding a veto,
00:21:56.784 --> 00:22:00.244
So because... Is it worth spending the political capital on?
00:22:00.384 --> 00:22:05.224
That's it. Yeah. You don't want to upset the governor if you are going to lose out later.
00:22:05.524 --> 00:22:11.724
So it's sometimes a tricky dance on what the optics look like.
00:22:11.944 --> 00:22:15.004
Well, this has been super helpful, Logan. Thank you so much. Thank you.
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"You also want to know when the law is actually in effect in case we want to pursue any enforcement. If we need to go to whoever the enforcement mechanism is and ask them to step in with a non-compliant manufacturer, that timing is important. However, it’s really hard. This is something I learn every day, because different states handle this process very differently. The way bills go into effect can vary a lot. For example, with some of the recent contract pharmacy restrictions, in New Mexico the law doesn’t go into effect until January."
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