An Update on Hazardous Drugs Rules + New Prior Authorization Legislation. Jonathan C. Britell MD FACP April 19, 2013

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1 An Update on Hazardous Drugs Rules + New Prior Authorization Legislation Jonathan C. Britell MD FACP April 19, 2013

2 An Update on Hazardous Drugs Rules The 2011 Legislature passed Engrossed Substitute Senate Bill (ESSB) 5594, requiring the Department of Labor & Industries (L&I) to set requirements to protect workers who handle chemotherapy and other hazardous drugs.

Department of Labor & Industries (L&I) to set requirements to

3 An Update on Hazardous Drugs Rules The bill required L&I to adopt rules that are consistent with but do not exceed provisions in the National Institute for Occupational Safety and Health s (NIOSH) 2004 Alert on preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings, as updated in 2010.

Occupational Safety and Health s (NIOSH) 2004 Alert on preventing occupational

4 Initial Implementation Schedule By: January 1, 2014 July 1, 2014 January 1, 2015 Employers Must: Complete and Implement Written Hazardous Drug Control Program Implement Employee Training Install Appropriate Ventilation

and Implement Written Hazardous Drug Control Program

5 Hazardous Drug Advisory Committee was formed to advise Labor and Industries about: 1. New recommendations from the National Institute of Occupational Health and Safety (NIOSH). 2. Scientific and technological developments. 3. Other unanticipated issues related to implementation of the hazardous drug handling rule.

New recommendations from the National Institute of Occupational Health and

6 Hazardous Drug Advisory Committee

8 The rule applies to all employers in health care facilities that have employees with occupational exposure to hazardous drugs. For the purpose of this rule, health care facilities are defined as places where a health care provider provides health care to patients, including: Hospitals Clinics Nursing homes Laboratories Offices Veterinary medicine clinics Retail pharmacies Home health care agencies Research laboratories where a health care provider offers health care to patients

For the purpose of this rule, health care facilities are defined as places where a health care provider provides health

9 Affected workers could include: Pharmacists and pharmacy technicians. Physicians and physician assistants. Nurses. Patient care assistants, such as health care assistants or nursing assistants. Operating room personnel. Home health care workers. Veterinarians and veterinary technicians. Environmental services employees in health care facilities, including workers involved with housekeeping, laundry, or waste disposal. Employees in health care facilities who ship or receive hazardous drugs from the manufacturer or distributor.

Veterinarians and veterinary technicians.

10 The written hazardous drugs control program must be created with input from workers and address the following elements as applicable to the facility: A written inventory of hazardous drugs in the workplace. A current hazard assessment for each hazardous drug. Hazardous drugs policies and procedures that cover, but are not limited to: Engineering controls (equipment use and maintenance). Personal protective equipment (PPE). Safe handling practices (receiving and storage, labeling, preparing, administering, and disposing of hazardous drugs). Cleaning, housekeeping, and waste handling. Spill control. Personnel issues (such as exposure of pregnant workers). Training.

Hazardous drugs policies and procedures that cover, but are not limited to: Engineering controls (equipment use and maintenance). Personal protective equipment (PPE).

11 Washington State Labor and Industries Webpage

15 Sign on to the Listserv to stay up to date on rule developments.

20 Issues: Complexity of task Lack of data Development of Hazardous Drug Policies for: Handling Preparation Administration Disposal Clean up

21 Current Status of Best Practice Development: Flowchart for Handling Completed

22 Flowchart for Handling Hazardous Drugs Before Preparation

23 Flowchart for Handling Hazardous Drugs Before Preparation

24 Current Status of Best Practice Development: Flowchart for Handling Completed Next Phase: Preparation procedures Administration procedures Disposal and Spill Clean Up procedures

25 Major Development Implementation of all phases delayed 1 year! Likely schedule: January 1, 2015 develop written control plan July 1, 2015 employee training January 1, Install appropriate ventilation systems

26 Labor and Industries Website Important web addresses: Hazardous Drugs page: default.asp List Serv: Hazardous Drugs List Serv- access on Hazardous Drugs page

27 Legislation of Interest SB 5267 Standardization of Prior Authorization for Prescription Drug Benefits Chief Sponsors: Senator Randi Becker ***** Senator Karen Keiser Representative Eileen Cody Representative Laura Jinkins

28 Current Prior Authorization Processes -Create confusion due to multiplicity of forms -Cause Delays in initiating urgent chemotherapy -Cause Patients unnecessary anxiety and cancer related symptoms awaiting approval -Create Unnecessary and Unreimbursed Practice Costs How many FTEs have you dedicated to this? -Patients frequently change insurance and have to have more prior authorization for a scheduled and ongoing treatment.

29 SB 5267 Initial Requirements: Maximum of 4 forms to be used by all insurers for prior authorization of prescription drug benefits 2 business day turnaround Implementation Jan 1, 2015 Senate Health Care Committee Passed Feb 22, 2013

30 First Amended version: SSB 5267 Insurers could get insurance commissioner to approve their own forms if all required data present (perpetuated current situation) Senate Ways and Means March 13, 2013

31 Second amended version: SSSB 5267 Chairs of House and Senate Health Care Committees will appoint a panel of 11 members to develop standard forms. Deadline for creating forms: November 1, 2013 NO IMPLEMENTATION REQUIREMENT Passed by Entire Senate 49-0 March 13, 2013

32 House of Representatives Action: April 1, 2013 Passed amended bill to require: a) Forms to be agreed upon by November 15, b) Implementation effective July 1, c) Applies to drugs, medical procedures and tests. House Health Care & Wellness Committee E2SSB 5267

33 E2SSB 5267 House Ways and Means Committee

34 What Can and Should You Do?

35 What Can and Should You Do? 1.Find and contact your legislators!!!

36 Find Your Legislators

38 Contact Your Legislators!!! and tell them what SB 5267 and standardized prior authorization means to you, your practice, and most importantly to your patients and their constituents PS: Include your home address and phone number and invite them to visit your practice and learn first hand about this issue.

39 Questions or Comments?

S.B. NO.2b72 JAN 2 2 2016

S.B. NO.2b72 JAN 2 2 2016 S.B. NO.b JAN 0 A BILL FOR AN ACT THE SENATE TWENTY-EIGHTH LEGISLATURE, 0 STATE OF HAWAII RELATING TO ADVANCED PRACTICE REGISTERED NURSES. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: SECTION.