Lansing — Licensed pharmacists would be able to dispense prescription drugs through up to two remote pharmacies under legislation approved Thursday by the Michigan Senate.

Supporters say the proposal would improve access for Michigan residents who live in rural communities or other areas without licensed pharmacists, but critics fear the measure could increase the opportunity for illegal prescription drug diversions amid an ongoing opioid crisis.

“I think we put enough checks and balances in this bill to make sure that that won’t happen,” said sponsoring Sen. Curt VanderWall, R-Ludington.  “Ultimately what we’re trying to do is make sure there’s better patient care.”

The legislation would allow for remote dispensing pharmacies in areas without an existing pharmacy within 10 miles, a requirement the state could waive upon evidence of other factors limiting patient access.

A licensed pharmacist would oversee the facility remotely by video, ensure it is staffed by qualified technicians, consult with patients and view a digital image to verify the accuracy of each prescription before it is dispensed.

Sen. Mallory McMorrow, D-Royal Oak, opposed the measure, citing concerns she has heard from Oakland County pharmacists worried the bill does not include strong enough security measures to prevent mistakes or intentional drug diversions by technicians.

The legislation would allow up to 225 prescriptions per day through remote pharmacies, but McMorrow said one of the pharmacists she talked to fills about 75 prescriptions a day and is “very busy” at that rate.

“So if you’re a pharmacist already dispensing up to 75 medications in your facility, and now remotely monitoring two more facilities, it increases the risk that you’ve got a tech who might be diverting drugs or that the counts aren’t accurate,” McMorrow said.

“So I want to make sure, particularly as we think about the opioid epidemic, that we’re not unintentionally increasing harm to residents.”

The measure cleared the Senate 32-6, with support from all Republicans and 10 Democrats.  It now heads to the state House for additional consideration.

The bill is backed by Cardinal Health, a multinational pharmaceutical distributor headquartered in Ohio and Ireland. As the Michigan Campaign Finance Network reported this week, many Michigan counties have sued Cardinal and other distributors for their alleged role in the opioid crisis.

But those are “blanket” suits that “attack just about anybody that’s got an opioid that it's sold at one point in time,” VanderWall said, downplaying concerns over the company's role in the legislation.

“That’s a whole different subject,” he said of the litigation. “I don’t think that makes a difference on what this bill is. If people want to try to tie it together, that’s too bad.”

VanderWall said the proposal would give patients in rural areas greater ability to consult with a pharmacist remotely, a virtual one-on-one talk that may not happen if they get prescriptions filled by mail.

There will be “more opportunity for a patient to visit with a pharmacist and get the true knowledge of what that prescription that they just purchased will do. and ultimately patient care is the No. 1 goal,” he said.

Cardinal Health lobbyist Adam Chesler touted the legislation to Michigan lawmakers in a May hearing. He told them 23 other states allow remote pharmacy locations, calling it a “proven model” that is both safe and effective.

“Making pharmacists more accessible results in significant improvements in patient’s care, the individual’s health and the health of their entire community, especially those that are currently lacking a pharmacist,” Chesler said in testimony before the Senate Health Policy and Human Services Committee VanderWall chairs. 

Cardinal has worked on the legislation with various state health associations, including the Michigan Association of Health Plans and the Michigan Health and Hospital Association, which have both offered conceptual support for the bill.

But the Macomb County Pharmacists Association has sounded alarms over the legislation, arguing it could “fuel the opioid crisis in Michigan" without additional amendments.

While the legislation requires a pharmacist to visually inspect an image of each prescription, the pharmacist would lose the ability to “examine the tactile feel” of the medication, the group said in a June statement.

And overseeing their own facility and two remote locations could “overwhelm a pharmacist’s ability to adequately monitor prescriptions for misuse and abuse.”

McMorrow said she hopes the bill will be revised in the Michigan House to include more security measures. She also questioned how remote telepharmacy systems would work in rural areas that do not have broadband access.

Under the proposal, a remote pharmacy would have to temporarily close to the public if any component of the telepharmacy system is malfunctioning and there is not a licensed pharmacist on the premises.

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