Lawmakers let medication access plan die after Baker veto

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BOSTON >> Leading up to end of formal legislative sessions last weekend, House and Senate lawmakers seemed determined to ease patient access to mental health and substance abuse medications this summer by allowing registered pharmacists to administer the drugs under the direction of a doctor.

The legislation, however, died at midnight Sunday by gubernatorial veto, and days later nobody involved in the debate was available or could explain why.

The Legislature included in its budget a section allowing registered pharmacists to administer mental health and substance abuse medications. Pharmacists say the measure would have improved access by making it more convenient for patients to keep appointments for weekly or monthly injections at their local pharmacy.

Gov. Charlie Baker supported the concept, but returned the section with an amendment that would have first required the Department of Public Health, in consultation with the Board of Registration in Pharmacy and the Department of Mental Health, to develop regulations.

"I support the intent of this section to expand access to such medications in appropriate circumstances," Baker wrote to lawmakers. "However, many mental health and substance abuse medications have the potential to cause serious consequences, including adverse medical reactions and fatal overdoses. Such medications should be administered by clinically trained staff, together with close supervision and counseling."

Baker filed his amendment on July 11 and three days later the House and Senate rejected it on a 35-124 vote in the House and a voice vote in the Senate. The Legislature reenacted its original bill on July 18. Baker waited the full 10 days afforded to him for review before vetoing the bill (H 4489) on the Friday before the last two marathon formal sessions of the year on Saturday and Sunday, July 30 and 31.

"(Pharmacists) do it in about half of the states for this type of medication. This is a patient population where adherence is difficult and any convenience that you can provide helps. Pharmacies are pretty good at getting people to come to appointments," said David Johnson, executive vice president of the Massachusetts Pharmacists Association.

Johnson said the association considered Baker's amendment "unnecessary" and worried it could delay the improved access for at least one to two years while pharmacists waited for regulations, but the group did not take a position for or against the amendment.

"We think the Board of Pharmacy is capable of producing a policy or a guidance, but we didn't fight it either," he said of the governor's counter proposal.

Asked why the Legislature didn't override the veto, Johnson said, "I honestly don't know. It's very confusing because why would you let it lapse when you took the step to reject the amendment calling for regulations. It seemed they were poised to override the veto at this point and I have no idea why they didn't take that step."

The House waited until Thursday, Aug. 4 to introduce Baker's veto message, announcing it during a lightly attended informal session and putting it on the House calendar. But since the Legislature will only meet in informal sessions over the next five months and therefore cannot override any gubernatorial vetoes, the proposal appears dead until it can be refiled for the 2017-2018 session.

Neither Sen. Jennifer Flanagan nor Rep. Nick Collins, who sponsored similar legislation this session, were available Thursday to discuss what happened to the bill, and a spokesman for House Ways and Means Chairman Brian Dempsey did not respond to an email seeking comment.

The administration, according to a senior official, continued to advocate its position throughout the weekend, which could have influenced a change of mind among legislative leaders.

Baker, in his veto letter, said that without modifications the bill "unnecessarily compromises the health and safety of persons who are prescribed psychotropic medications for the treatment of mental health and substance use disorders" by allowing pharmacists to administer medications "without proper education and training and outside the context of the therapeutic prescriber-patient relationship."

"The best practice for treating mental health and substance use disorders involves a combination of medication, clinical treatment, psychosocial interventions, laboratory assessments, and support. Medications used in the treatment of mental health problems and substance use disorders carry a risk of serious adverse medical reactions, including fatal overdose. Accordingly, these medications should only be administered by clinicians trained to observe and monitor the patient and in the context of a true clinician-patient relationship that also includes treatment and engagement efforts," Baker wrote.

He said, "While pharmacists are trained in administration of some medications used to prevent certain illnesses, such as vaccines, pharmacists do not receive professional education or training in the administration of the broad array of powerful medications used to treat substance use disorder or mental illness."


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