The Arizona Board of Pharmacy — whose members are appointed by Governor Doug Ducey — opposed a bill that would give insurance companies access to a confidential prescription database.
Then, in an unexplained turn of events last week, board members voted to reverse their position.
Supporters of Senate Bill 1370, which is sponsored by Republican State Senator Kate Brophy McGee, say it could help curb the opioid epidemic by entrusting another party to keep an eye on suspicious prescription patterns.
But doctors and patient advocates warn that health insurers could misuse people's sensitive drug information to advance their business interests. They argue that doctors and pharmacists are much better suited for monitoring potential drug abuse through the Controlled Substances Prescription Monitoring Program (CSPMP), which keeps tracks of addictive prescriptions like opioids and anti-anxiety medication.
In a phone call with Phoenix New Times, the executive director of the National Association of Boards of Pharmacy (NABP) expressed concern that the bill could lead to insurance companies denying coverage to certain patients and practitioners.
NABP director Carmen Catizone also said that the bill, if it passes, could revoke Arizona's access to a national database of controlled prescriptions. Called NABP Interconnect, the program allows states to share prescription information with one another only if their access laws are consistent.
"If Arizona allows insurance companies to access it, and states say insurance cannot have access, Arizona would probably be precluded from getting data from all those other states," Catizone said.
The Arizona Board of Pharmacy, a member of the NABP, opposed the bill for similar reasons before dropping its opposition a week ago in a February 12 vote.
Board members won't explain what happened. But hours before the vote, the board's executive director, Kamlesh Gandhi, told a Senate committee that the board would reverse course.
That's problematic because Gandhi works for the board, not the other way around, raising questions about how he knew the outcome of a vote that had not happened yet.
All nine pharmacy board members declined to comment or did not respond to request for comment. Gandhi did not respond to emails, text messages, and voicemails seeking comment.
The strange run-up to the board's 180-degree turn started early last week.
On Monday, February 10, New Times reached out to Gandhi regarding a different CSPMP-related bill sponsored by Brophy McGee. That bill, SB 1568, would have let health care employers access the database to screen potential hires.
Gandhi spoke openly with New Times about his privacy concerns over the legislation. He shared a letter the board sent to Brophy McGee stating that passing SB 1568 would amount to "discriminating against a person’s disability." At the time Gandhi spoke with New Times, the board was also opposing SB 1370, the bill giving insurance companies access to the CSPMP.
Brophy McGee told New Times the next day that she decided to shelve SB 1568 until the next session over the "need for further research and discussion." Also that Tuesday, Gandhi attended a closed-door stakeholders meeting for the insurance-related SB 1370 with Brophy McGee.
New Times' report on SB 1568 was published on Wednesday morning. On that day, during the February 12 meeting of the Senate Health and Human Services Committee, committee chairperson Brophy McGee called up Gandhi to speak to the board's position on SB 1370.
"You previously signed in against," Brophy McGee said. "Following our stakeholder meeting yesterday, the board is for the legislation, and I would like you to speak to that."
"We did have concerns, and it was probably a misunderstanding. A misunderstanding on my part is probably why we chimed in opposition of the bill," Gandhi said, without elaborating further.
Brophy McGee thanked Gandhi for reversing his position. "It was clearly, clearly a misunderstanding," she later said.
Hours later, the Board of Pharmacy held a conference call during which they discussed reneging its opposition to the bill. At no point during the call did Gandhi tell board members what he had told the committee about the board's position, according to a recording of the call posted online.
Gandhi told board members that his stakeholders meeting with Brophy McGee allayed concerns he had about the legislation, pointing to a part prohibiting insurers from using the CSPMP for "any purpose other than preventing overuse or abuse of controlled substances."
He also suggested to members that Ducey supports the bill, saying that it is an "extra approach by the governor’s office to further create safety measures for residents of Arizona."
Ducey spokesperson Patrick Ptak later declined to comment, stating: "We do not comment on pending legislation."
While some board members on the call were swayed by Gandhi, others remained unconvinced. Board member Mohammad Salari, a pharmacist, repeatedly questioned why insurance companies should have any role in the CSPMP.
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"I am just not sure why the insurance company needs to have input into this. The input needs to be from the physician who is evaluating the patient and the pharmacist who is taking care of the patient on the dispensing end," Salari said. "I don't see insurance companies making the decisions in the best interest of patients, necessarily, with access to this data."
Kyra Locnikar, a public member of the board, said she understands giving law enforcement access to the database, but not insurance companies.
"I’m all for police departments and licensing boards, but as far as commercial insurance policies, I do not understand their interest in that," Locnikar said.
With these concerns by some members, the board voted 4 to 3 during the call to reverse its position on SB 1370.