CCS/HCS/SCS/SB 139 - This act modifies provisions relating to health care. EMERGENCY ADMINISTRATION EPINEPHRINE (Section 196.990): This act allows a physician to prescribe epinephrine (EPI) auto-injectors in the name of an authorized entity for use in certain emergency situations. Pharmacists, physicians, and other persons authorized to dispense prescription medications may dispense EPI auto-injectors under a prescription issued in the name of an authorized entity. An "authorized entity" is defined as any entity or organization at or in connection with locations where allergens capable of causing anaphylaxis may be present, including but not limited to restaurants, recreation camps, youth sports leagues, amusement parks, and sports arenas. This act also allows such authorized entities to acquire and stock a supply of EPI auto-injectors under a prescription issued in accordance with the provisions of the act. An employee or agent of an authorized entity or any other person who has completed the required training shall be allowed to use the EPI auto-injector on the premises of or in connection with the authorized entity to provide it to any individual who the employee, agent or other person believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for the EPI auto-injector or has been previously diagnosed with an allergy. The employee or agent shall not administer or provide the auto-injector to a person who is eighteen years of age or younger without the verbal consent of a parent or guardian who is present at the time, unless the child will be in imminent danger without the use of the auto-injector. The act specifies the required training and the procedures for making the EPI auto-injectors available to individuals other than trained persons, as long as the auto-injectors are secured and properly stored. The act also requires all basic life support ambulances and stretcher vans to be equipped with EPI auto-injectors and staffed by at least one person trained in the use of the auto-injectors. This act exempts certain persons and entities from liability for any injuries or related damages that result from the administration or self-administration of an EPI auto-injector in accordance with the provisions of the act that may constitute ordinary negligence. The immunity shall not apply to acts or omissions constituting reckless disregard for the safety of others, or willful or wanton conduct, and shall be in addition to and not in lieu of the protections provided under the Good Samaritan emergency law. No trained person who is in compliance with this law and who in good faith and with reasonable care fails to administer the EPI auto-injector shall be liable for that failure. These provisions are identical to HB 761 (2017) and SB 677 (2016), substantially similar to SS/SCS/SB 26 (2015) and HB 96 (2015), and similar to SB 868 (2014) and HB 1568 (2014). POLYPHARMACY & ANTIPSYCHOTIC MEDICATIONS (Section 208.227): This act repeals existing language relating to psychotrophic medications and adds new language relating to the establishment of a polypharmacy program and the prescribing of antipsychotic medications. The MO HealthNet Division shall establish a polypharmacy program for high-risk MO HealthNet participants with numerous or multiple prescribed drugs. The Division shall also establish a behavioral health pharmacy and opioid surveillance program to encourage the use of best medical evidence-supported prescription practices. The Division shall issue provider updates to enumerate specified treatment and utilization principles for MO HealthNet providers, including treatment principles relating to antipsychotic drugs. If the Division implements any new policy or clinical edit for an antipsychotic drug, the Division shall continue to allow MO HealthNet participants access to any antipsychotic drug that they use and on which they are stable or that they have successfully used in the past. Additionally, the following shall apply to the prescribing of antipsychotics: (1) If an antipsychotic drug is listed as "non-preferred" by the Division and is considered clinically appropriate for an individual patient, prior authorization shall be simple and flexible; (2) If an antipsychotic drug is listed as "non-preferred" and is known or found to be safe and effective for a patient, the Division shall not restrict the patient's access to the drug and such drug shall be considered "preferred" for that patient; (3) A patient shall not be required to change antipsychotic drugs due to changes in medication management policy, prior authorization, or a change in the payor responsible for the benefit; and (4) Patients transferring from state psychiatric hospitals to community-based settings shall be permitted to continue their medication regimens. The Division's medication policy and clinical edits shall provide MO HealthNet participants initial access to multiple FDA-approved antipsychotic drugs that have substantially the same clinical differences and adverse effects that are predictable across patients and whose manufacturers have entered into rebate agreements with the federal Department of Health and Human Services. The act specifies the categories of available drugs that shall be made available to participants. These provisions are identical to provisions in HCS/HB 986 (2017), substantially similar to provisions in SCS/SB 433 (2017), and similar to provisions in HB 1159 (2017). PRESCRIPTION DRUG REBATES (Section 208.229): Under this act, pharmaceutical manufacturers shall pay to the state of Missouri, in accordance with federal law, rebates on eligible utilization of covered outpatient drugs dispensed to MO HealthNet participants as follows: (1) for single source drugs and innovator multiple source drugs, rebates shall reflect the manufacturer's best price; and (2) for single source drugs and innovator and noninnovator multiple source drugs, any additional rebates as necessary to account for certain price increases in excess of inflation. These provisions are identical to provisions in HCS/HB 986 (2017), substantially similar to provisions in SCS/SB 433 (2017), and similar to provisions in HB 1159 (2017). MISSOURI RX PROGRAM (Sections 208.790 & 208.798): The act modifies provisions relating to the Missouri Rx Prescription Drug Program by requiring applicants' household income limits for eligibility to only apply to Medicaid dual eligible individuals. The provisions of the Missouri Rx Program are extended and shall sunset on August 28, 2022. These provisions are identical to provisions in HCS/HB 986 (2017). DELEGATION OF PHYSICAL THERAPY TREATMENT (Section 334.506): Currently, a physical therapist may delegate physical therapy treatment to a person in an entry level of a professional education program approved by the Commission for Accreditation of Physical Therapists and Physical Therapist Assistant Education. This act modifies the name of the relevant commission to the Commission on Accreditation in Physical Therapy Education (CAPTE). RX CARES FOR MISSOURI PROGRAM (Sections 338.700 & 338.710): This act also creates the Rx Cares for Missouri Program to be administered by the Board of Pharmacy in consultation with the Department of Health and Senior Services. The goals of the program are to promote medication safety and prevent prescription drug abuse. The Board may expend funds appropriated to the Board to private and public entities for the development of programs and education in order to meet these goals. Funds shall not be used for any state prescription drug monitoring program. The Board of Pharmacy may enter into interagency agreements with the Department of Health and Senior Services so that the Department may assist in the operation of the program. The program shall expire on August 28, 2019. These provisions are substantially similar to SB 1136 (2016). JAMIE ANDREWS