Will Humble Reproductive Health, Wills Blog

Az Pharmacists Can Now Dispense Contraceptives w/o a Physician Prescription

Back in 2021 the state legislature passed, and the governor signed a bill giving pharmacists the ability to dispense oral and other contraceptives that currently require a prescription to fill.

The law didn’t take immediate effect because the AZ Board of Pharmacy needed to write rules outlining things pharmacists need to do in order to dispense without a prescription. Those rules were approved by the Governor’s Regulatory Review Council on Wednesday.

Today (Thursday) ADHS’ Chief Medical Officer for Public Health (Lisa Villarroel, MD MPH) issued a thorough Standing Order for the Self-administration of Hormonal Contraceptives, including the self-screening questionnaire… the final piece of the puzzle needed for pharmacists to dispense those kinds of contraceptives without an initial doctor visit or physician prescription.

View ADHS’ Standing Order and Self-screening Questionnaire

As with pretty much any public health intervention, there are benefits and risks. On the benefit side, the measure will improve community health and well-being by improving access, make it easier to space pregnancies (which improves maternal and child health).

On the risk side, there is a chance some women will skip annual checkups and screenings. There are also some medical conditions that put women at higher risk for side effects from oral contraceptives that could be missed under the new system, which is why the statute, and the Board of Pharmacy rules require that the pharmacist review the self-assessment before filling the order.

View the proposed rules: 4 AAC 23_March 21, 2023

View the Statute View ARS 32-1979.01

The Arizona Section of the American College of Obstetricians and Gynecologists supports the new law and the Board’s rules: See their Letter  

“By implementing the 2021 legislation, these rules will improve access to these types of contraceptives, especially for low-income patients and those who live in rural areas. Self-administered hormonal contraception improves community health and well-being, reduces global maternal mortality, creates health benefits of pregnancy spacing for maternal and child health and allows for mothers to engage in economic self-sufficiency.”

Since 2012 ACOG has endorsed this model of access to hormonal contraception to minimize barriers to access. Studies have shown these medications can be safely dispensed using the health risk screening questionnaire that is required in the legislation and reflected in the rules— this will help women and their pharmacists determine which medication is right for them and what is safe based on their individual health history.”

AzPHA supported the 2021 bill that set this intervention in motion because we believed that the public health benefits of greater access outweigh the risks. We look forward to the ADHS self-assessment screening guidance and standing orders so this intervention can be implemented.

Arizona could begin giving expanded access to birth control in July (azcentral.com)

Pharmacists will be able to dispense birth control to women without prescriptions | Arizona Capitol Times (azcapitoltimes.com)

Will Humble Climate Change, Wills Blog

APS Doubles Down on Coal & Sticking Us with the Tab: Send them Back to the Drawing Board

Arizona Public Service Company (APS) is asking the Arizona Corporation Commission for a rate increase that extracts $460 million more from captive ratepayers, a whopping 13.6% net increase on monthly bills.

We understand public utilities like APS have capital needs and variable costs that periodically require rate increases to ensure a reliable supply of energy and meet expected peak demands.

What we don’t understand is why APS is asking us to pay hundreds of millions more so they can continue to operate the inefficient coal fired Four Corners power plant into the next decade. Especially since there are cheaper and cleaner ways to serve the public that don’t carry the public health impacts such as increases in asthma and bronchitis that prolonged burning of fossil fuels does in communities. 

Since the last rate case, APS has spent hundreds of millions of dollars in capital expenses, operations, and maintenance at the inefficient Four Corners Generating Station and Cholla Power Plant. Now the company is asking us to pony up hundreds of millions more to keep Four Corners running until 2031 even though it is no longer economical to run and more costly than clean energy alternatives. 

With better planning, the utility could get cleaner energy sources with lower operating costs that would moderate this excessive rate increase request.

APS Doubles Down on Coal & Sticking Us with the Tab

Arizona Republic, June 27, 2023

APS could save ratepayers money, reduce pollution, and moderate their rate increase request by retiring the Four Corners Power Plant before 2031 and replacing it with lower-cost renewable energy. At a minimum, their plan should switch Four Corners to seasonal operations this year as APS originally promised. 

APS’ rate increase should also include more investments in energy efficiency, which can also reduce customer bills and lessen the burden on people with low incomes. They should be doubling down on investing in energy efficiency technologies like incentives for buying programmable thermostats, increasing incentives to participate in time-varying rate plans that reduce peak load without removing home comfort, and incentives for people to install more efficient HVAC systems, refrigeration, pool pumps, and industrial motors.

We understand utilities like APS require periodic rate increases to plan for growth, meet customer needs, and accommodate peak loads. However, APS’ request focuses too much on expensive and dirtier energy sources and not enough on cheaper, cleaner solar and wind, and more energy efficiency.

We urge the Arizona Corporation Commission to ask APS to go back to the drawing board and come back with a more reasonable proposal that focuses more on cheaper renewable energy and better leverages energy efficiency. 

Will Humble is executive director for the Arizona Public Health Association. Sandy Bahr is director of Sierra Club’s Grand Canyon (Arizona) Chapter. Reach them at [email protected] &[email protected] and on Twitter at @willhumble_az & @SLBahr

 

SUBMIT WRITTEN COMMENTS TO THE AZ CORPORATION COMMISSION DOCKET

  1. Be sure to include the docket number at the top of your comments – Docket Number E-01345A-22-0144
  2. Use the talking points listed below for your comments, plus include any specific reasons you are concerned about this rate case. Tell your story!
  3. You can mail your comments to:  Arizona Corporation Commission, Consumer Services Section, 1200 West Washington, Phoenix, AZ 85007
  4. You can submit your comments electronically or ask us to drop them off for you.
To submit a public comment, go to https://efiling.azcc.gov/cases, Click on “Make A Public Comment in a Docket.” Complete your information and click “Submit.”
Will Humble Uncategorized

Public Health Journalism This Week: Contraception, AZ State Hospital, Gender Affirming Care, Nursing Home Care, AHCCCS Enrollment

More oversight is needed at the Arizona State Hospital, critics say (azcentral.com)

Long-term care nursing residents at risk – Arizona PBS

Pharmacists will be able to dispense birth control to women without prescriptions | Arizona Capitol Times

Arizona could begin giving expanded access to birth control in July (azcentral.com)

Arizona will spend more on homelessness this year than it ever has before | KJZZ

The divide over Ozempic and other drugs touted for aiding weight loss (azcentral.com)

Hobbs orders give trans state employees access to surgery, bar state money for ‘conversion therapy’ (azmirror.com)

Arizona Gov. Hobbs signs executive order on transgender medical access (azcentral.com)

150,000 dropped from Medicaid coverage in Arizona, most for filing errors (azmirror.com)

Senate alters governor nominee review process / AZ Capitol Times

Reports

NEW REPORT: “Why Medicare Needs the Power to Negotiate for Lower Drug Costs: Outrageous Prices, Greed, and Patent Exploitation” — Protect Our Care

Will Humble Healthcare, Medicaid, Wills Blog

Medicaid & Gender Affirming Care: A Primer

Update on Medicaid Coverage of Gender-Affirming Health Services

Under Medicaid, states must cover certain mandatory benefits, such as inpatient and outpatient services, home health services, and family planning services. There aren’t specific federal requirements regarding coverage or exclusion of gender-affirming health care services as a category of Medicaid benefits, but there are rules regarding comparability that say “services must be equal in amount, duration, and scope for all beneficiaries within an eligibility group”.

Medicaid benefits are subject to Section 1557 of the Affordable Care Act which prohibits discrimination based on sex. The Biden Administration recently proposed a new rule on Section 1557 that explicitly states that sex-based protections to include sexual orientation and gender identity.

In a survey of states on coverage of sexual and reproductive health services conducted in Summer 2021, KFF and Health Management Associates asked states about coverage of five gender-affirming care services: 1) gender-affirming counseling; 2) hormones; 3) surgery; 4) voice and communication therapy; 5) fertility assistance for transgender enrollees.

Interestingly (given the nature of the previous administration) AHCCCS covers 3 of the 5 gender affirming care services when medically necessary (for adults): Gender affirming hormone therapy, gender affirming voice/communication therapy and mental health services. The two services not covered by AHCCCS are gender affirming surgery and fertility services.

The Full KFF report of the survey findings are posted at Update on Medicaid Coverage of Gender-Affirming Health Services | KFF.
Will Humble Healthcare, Public Health, Wills Blog

Hobbs Issues Pair of Executive Orders: Expanding Coverage for Gender Affirming Care & Prohibiting State Support for Conversion Therapy

Governor Hobbs issued an Executive Order Tuesday that will allow state employees to access gender-affirming surgery. In a related Order, she ended any state involvement in “conversion therapy”.

One Order directs ADOA to remove a prohibition on state employee health plan coverage for gender-affirming surgery. That limitation was initiated in Ducey’s first term (2017). The Order also stops state agencies from cooperating with civil or criminal cases in other states where gender affirming care is banned.

See the Executive Orders

The other Order prohibits state agencies from promoting or supporting “conversion therapy,” a practice that IS NOT evidence-based that attempts to change a person’s sexual orientation or gender identity.

Note: AZPHA has a long history of supporting health equity including for those in the LGBTQ+ community. In 2021 AzPHA members approved this Resolution Eliminating of the Use of Conversion Therapy Practices for LGBTQ Individuals
Will Humble Vaccination, Wills Blog

FDA Advisory Committee Unanimously Recommends Moving to a Strictly Omicron-focused COVID Vaccine this Fall

FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) met on June 15, 2023, to discuss and make recommendations for SARS-CoV-2 strain(s) for updated COVID-19 vaccines for use in the United States beginning in the fall of 2023.

The committee unanimously voted that the vaccine composition be updated to a monovalent COVID-19 vaccine with an XBB-lineage of the Omicron variant for the 2023-2024 formulation of the COVID-19 vaccines for use beginning this fall. 

“Based on the totality of the evidence, FDA has advised manufacturers who will be updating their COVID-19 vaccines that they should develop vaccines with a monovalent XBB 1.5 composition.”

See: Vaccines and Related Biological Products Advisory Committee June 15, 2023 Meeting Announcement – 06/15/2023 | FDA

Will Humble State Legislature, Wills Blog

Legislative Session Summary PowerPoint & Webinar

It’s fair to say that the 2023 Legislative Session was like no other in Arizona history. A record number of bills were vetoed, yet a bipartisan budget was passed relatively quickly. Here’s a PowerPoint that briefly summarizes the session along with links to the actual bills themselves. 

You’ll see there were actually several good bills that passed including some important gains in the budget like a big infusion into the Housing Trust Fund and some funding to set up Teaching Health Centers to build more primary care residency slots in rural and underserved areas.

The bills that were harmful to public health were vetoed, but a couple of new ballot measures will be on the 2024 ballot that would be harmful -especially the referendum that would limit public health emergencies to just 30 days unless the legislature renews it in additional monthly increments (governors can’t veto legislative ballot referrals).

There were also many missed opportunities to improve public health and government accountability – good bills that either died in committee, failed on the floor, or were amended at the 11th hour to neuter them.

Here’s where you can See the Slide Deck summarizing those bills.

View Our Webinar Summarizing the 2023 Legislative Session
https://us06web.zoom.us/rec/share/ldRywI3Z4ZuX4ugx0N4QwwHUrmIEqygyYHfgOL6Z33WJ1p89aj56R6Fa8oCYjQy2.0XsJLrgKnAbQEwkT
Passcode: 5=5FjjNC

 

 

Will Humble Public Health, Wills Blog

AZ Public Health Journalism this Week

Will Humble Reproductive Health, Wills Blog

Governor Hobbs Issues Reproductive Rights Executive Order 

Governor Hobbs issued an executive order last week which gives Attorney General Kris Mayes prosecutorial authority over any abortion prosecutions in Arizona – removing that authority from the various county attorneys in AZ.  

The Executive Order states that the AG “… shall assume duties with regard to any criminal prosecution of a medical provider or other entity or individual that is pending or brought in the future by the county attorney of any county” that is related to abortion care.

The order also prohibits state agencies (mostly ADHS and various Boards) from “... participating in or assisting an investigation of unlawful abortion procedures” (unless required by a court order) and states that Arizona won’t extradite anyone charged with abortion-related crimes in another state.

The Order also creates a new committee to study abortion access and provide recommendations to the governor. Here’s where you can read the Executive Order.

Note: This action will no doubt be court.

Will Humble Public Health, Social Determinants, Wills Blog

Cultivating Inclusion: A Free Health & Athlete Leadership Conference

Special Olympics Arizona would like to invite you to attend the inaugural “Cultivating Inclusion: A Health and Athlete Leadership Conference” on Saturday, August 5th at Desert Willow Conference Center in Phoenix. This conference is open to health professionals, health professional students, and SOAZ athletes.

Join us as we discuss the importance and workings of inclusive health and hear directly from those with intellectual and developmental disabilities about their lived experience during this interactive day. Registration is free and includes a continental breakfast, buffet lunch, and snack. Registration is open and will close July 31st, or when no more spots are available.

Click Here to Register

Special Olympics Arizona’s (SOAZ) goal is to empower Arizonans with intellectual disabilities to be healthy, productive, and respected members of society through SOAZ’s year-round sports training, competitions, and support program. SOAZ believes that all people – with or without intellectual and developmental disabilities (IDD) – should have equitable access to quality health care, education, and services in their communities and SOAZ aims to strengthen the capacity of health organizations, providers, educators, and influencers, to make policies, programming, services, research, trainings and funding streams inclusive and accommodating of people with IDD.

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