Resolutions Working for You

CMS leads the way vetting and introducing resolutions to state and national bodies

AS THE GRASSROOTS launch site for physicianled reforms, the Chicago Medical Society is advancing more resolutions in areas as diverse as medical education, controlled substance licensure, and pharmacy benefit management. These efforts, which were adopted by the CMS Council on Sept. 10, ask both the Illinois State Medical Society and the American Medical Association to implement the measures via legislation or through regulatory action. Other resolutions still being debated by the Council include a proposal to inform the public of the amount of time physicians spend on data entry.

The Chicago Medical Society surpasses other Illinois county medical societies when it comes to vetting and introducing resolutions. Whether in Chicago, or Springfield, or Washington, resolutions originating at CMS make an impact.

Here’s a brief recap of the Council resolutions:

Medical Education Costs
The Chicago Medical Society is advancing a new principle for citing the cost of medical education. That principle encompasses much more than medical school tuition. It includes other financial burdens medical students incur such as housing, accrued loan interest, and the “opportunity cost” of postgraduate medical training from wages not earned. In policy discussions, CMS will reference data on the overall cost of medical education, according to the principle. CMS is requesting both ISMS and AMA to adopt the principle as a more accurate description of medical education costs.

Controlled Substances Licensure
The Chicago Medical Society measure protects physicians who elect not to prescribe controlled substances within their scope of medical practice. Hospitals and health plans should not require such physicians to maintain a controlled substance license as a condition for privileges and acceptance into insurance plan networks, according to the new CMS policy. The resolution requests ISMS and AMA to support this right and to consider introducing legislation that removes the requirement to maintain a controlled substance license for physicians whose scope of medical practice does not include prescribing of controlled substances.

Pharmacy Benefits Managers
The Chicago Medical Society is adding to Illinois’ new regulatory framework for pharmacy benefit managers with the following provisions:
• Requires PBMS operating in Illinois to make all pharmaceutical cost and coverage information (such as cost sharing, utilization management policies, formulary availability and therapeutic alternatives) available in an easily accessible format so that it may be accessed by patients, physicians and pharmacists as necessary prior to writing, dispensing or purchasing prescription medication. Accessible formats include: a non-password protected web site; regular and large type print format upon request; voice or TTY activated phone options.
• Requires PBMs to update this information regularly.
• Requires PBMs to provide patients with written notification of medication denials that includes the reason for denial and a list of covered potential therapeutic alternatives and associated out-of-pocket cost estimates.
• Requires PBMs to honor a prescription for the full duration of the prescription and not be limited to the plan year.
• Provides that all enrollees be notified at least 60 days prior to formulary changes or changes on medications among coverage tiers.