Lawmakers pass drug vending bill

The state Legislature on Tuesday unanimously passed a controversial bill that will allow pharmacists to use remote dispensing machines to help low income residents in rural areas improve their access to prescription drugs.

Senate Bill 2459 evolved through a mixed batch of criticism, including pages of testimony from several Kaua‘i pharmacists.

“It was contentious at times,” state Sen. Gary Hooser, D-Kaua‘i, said Friday. “There was a lot of misunderstanding about the intent of the legislation, but I’m confident that we’ve provided a good compromise.”

Kalaheo Pharmacy Manager Catherine Shimabukuro in late March testified that the bill fails to meet the guidelines of the National Association of Boards of Pharmacy.

“It is clear to me that the intention of the Legislature is to provide prescription care to those who are without insurance,” she says. “This is a noble goal but misguided in its approach to a solution. There are many other avenues that can address this need and all are viable and doable without rewriting the laws that govern the practice of pharmacy.”

Among her arguments, Shimabukuro says there is ample access to pharmacies — negating the need to have remote dispensing machines.

There are some 227 permitted pharmacies in the state, which has a population of nearly 1.3 million residents, according to the state pharmacy board.

State Rep. Roland Sagum, D-16th District, said access means more than physical locations.

“The pricing of these subscription drugs is much cheaper than they can get at a pharmacy,” he said. “It’s for our people who are poor and the indigent.”

The bill, which sunsets in five years, will allow Ho‘ola Lahui Hawai‘i to resume the telepharmacy service that ended two years after it started in October 2005.

Ho‘ola Lahui, a federally qualified health center and Native Hawaiian health care system with offices in Lihu‘e, provides drugs to patients at Kaua‘i Veterans Memorial Hospital in Waimea and Samuel Mahelona Memorial Hospital in Kapa‘a.

“This is especially important for uninsured patients who would not otherwise obtain the drugs they need to improve their immediate health,” Ho‘ola Lahui Board Director Grace Kamai says in her testimony. “HLH provides these medications at a reduced cost to those who otherwise would not be able to afford these medications. The technology allows HLH to reduce costs further by having a central pharmacy location … dispense acute medication at each clinic.”

Ho‘ola Lahui’s remote dispensing pharmacies were stopped in April 2007 after the state Board of Pharmacy clarified the rules that a pharmacist must be on-site to dispense medications from the machines, Kamai said.

This negated the need for the technology, increased the costs to dispense the necessary medications and decreased patient access to the drugs, according to David Peters, Ho‘ola Lahui chief executive.

Brian Carter, the pharmacist in charge at Lihu‘e Professional Pharmacy, questioned the health center’s motives.

“Ho‘ola Lahui has received money from the federal government to provide aid to the poor and needy people of Hawai‘i,” he said. “What Ho‘ola is doing is using the money that they have received, in good faith, to profit for themselves and put the pharmacies that have served this community for the past 50 years out of business.”

There are 10 independent pharmacies and seven chain retail pharmacies serving Kaua‘i by Carter’s count.

The state pharmacy board chair, Dr. Elwin Goo, testified in favor of the bill with amendments to track the remote dispensing pharmacies.

“The board supports the practice of remote dispensing and believes it is a technology that should be afforded to all pharmacies so that all residents of this state can be afforded easier access to prescription medications to meet their health care needs,” he says. “The board understands and sympathizes with the concerns of the legislature of the financial impact on the small independent pharmacies; however, this bill is not about financial gain or the prosperity of a business, but of the safe dispensing of prescription medications.”

Sagum said the bill is not meant to damage the business of established pharmacies.

“With our economy changing, our needy are getting bigger,” he said. “Many are having a hard time even buying groceries. We want to help them get through this transition time.”

Hooser said community health centers can dispense to very low-income people certain prescription drugs at the cheapest rate available to anyone.

Offering a hypothetical scenario, he said a patient can go to the health center where a doctor will prescribe medication and then have it filled at a remote pharmacy machine.

“It’s not like a vending machine at a shopping mall,” Hooser said. “It’s very controlled. Only certain medications are allowed to be dispensed and an off-site pharmacist does the record keeping.”

The patient will also be in contact with a technician via two-way sound and video monitoring devices, he added.

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