MAFP Testifies in Support of E-prescribing Legislation

Providing treatment at point-of-service increases patients' prescription compliance, improving health outcomes

September 9, 2021 - Today, on behalf of Michigan Academy of Family Physicians, Director of Government Relations Matt Black testified before the Michigan Senate Health Policy and Human Services Committee in support of House Bill 4659. This legislation would create exceptions to the requirement that prescriptions be transmitted electronically. Currently, there are 12 exceptions codified in the state's Public Health Code.
In order to align Michigan law with federal law, 2020 Public Act 134 amended the state's Public Health Code to, as of Oct. 1, 2021, require prescribers to electronically transmit prescritpions, including prescriptions for controlled substances, directly to the patient's pharmacy. Previously, electronic transmission had been optional.
This new electronic prescribing requirement is modeled after the Centers for Medicare and Medicaid Services' guidelines that require all controlled substance prescriptions be transmitted to a pharmacy electronically. With PA 134, Michigan went beyond CMS' requirement, requiring the same of all prescriptions.
Below is the testimony that Mr. Black delivered in support of HB 4659.

Good morning. Thank you, Chair VanderWall and members of the committee for the opportunity to speak to you today.

My name is Matt Black. I’m the Director of Government Relations for Michigan Academy of Family Physicians, who supports over 4,200 family medicine physicians, residents, and medical students. We urge your support of House Bill 4659, which would exempt dispensing prescribers from the new soon-to-take-effect electronic prescribing requirements.

We are seeking this exemption to remain in alignment with Centers for Medicare and Medicaid Services' guidelines, which this legislation is modeled after. CMS provided an exemption for doctors who prescribe in the updated regulations; however, dispensing prescribers would not be exempt under state legislation signed into law last year.

“Dispensing prescribers” in Michigan, who are most commonly Direct Primary Care physicians, are not licensed as a pharmacy but must obtain a license for each office location where prescriptions are dispensed. They can only dispense prescriptions to their bona-fide patients and must follow all state regulations regarding dispensing, labeling, and storage of prescriptions within their office. Most do not dispense controlled substances out of the office because they often do not have measures in place that are necessary to securely store and maintain controlled substances.

Frequently prescribed medications are generic prescriptions for some of the most common health problems treated in family medicine practice, which include diabetes, high blood pressure, and infections requiring antibiotics.

Most offices record inventory and dispensing information through their electronic health record. They can track all counts and medications from delivery to the office to dispensing to the patient.

Passage of House Bill 4659 would make Michigan statute consistent with federal guidelines and follow similar steps of at least six other states that have passed e-prescribing mandates where an exemption was included for out-of-office dispensing or dispensing prescribers.

Thank you for the opportunity to testify today.  I am happy to answer any questions you may have.

In May 2021, Adriana Raus, MD, a family physician who owns and practices family medicine at her direct primary care practice in Okemos, submitted similar supportive testimony to the House Health Policy Committee as it was considering HB 4659.

Among Dr. Raus' comments was that, "It is important for my patients, to reduce cost and provide faster relief, for me to continue to prescribe out of my office. If this change is not enacted, it could lead to greater negative health outcomes for patients across Michigan ... 40% of prescriptions transmitted to the pharmacy are either not filled or not started by the patient. Filling these in my office help increase compliance in patients' course of treatment."

Dr. Raus also shared the experiences of several of her patients who have benefited from her ability to prescribe out of her Okemos office.

"I recently had a mother who brought her sick child into my office. I was able to provide treatment and prescriptions at the point of service instead of requiring them to go to the pharmacy and wait for the prescription to be filled. Other patients are hard working community members who do not have insurance or prescription coverage and are able to manage chronic health conditions through the reduced costs from filling their prescription in my office," she explained.

Following approval of the House Health Policy Committee and the full House this summer, HB 4659 was sent to the Senate Health Policy and Human Services for consideration. Should the Senate panel approve the bill, it will head to the full Senate for a vote.