As their session draws to a close, California lawmakers are poised to approve at least two hotly disputed measures that could slow the growth of healthcare costs. One would allow nurses with advanced training to deliver more medical care, and another would open the door to less-expensive versions of pricey biologic drugs. Although the nursing bill was weakened in the face of opposition from doctors, it's still an important step in the right direction. The biologic drug measure, on the other hand, strays off course.
The nursing measure is one of three by state Sen.
In particular, Hernandez is no longer proposing to allow experienced nurse practitioners — registered nurses who have advanced degrees and clinical training — to work completely independently of physicians. Instead, his bill would allow them to work without a doctor's direct supervision if they were part of a medical team, such as in a clinic or a group practice.
The California Medical Assn., a trade group for doctors, has withdrawn its objection to the pharmacist bill but is still fighting the one for nurses. According to the association, even the amended SB 491 would still allow nurse practitioners to set up practices without physicians and to dispense narcotics with no effective oversight.
Those are hyperbolic complaints. The law wouldn't allow nurse practitioners to do anything they're not already licensed to do. And its clear intent is to give nurses more flexibility when they're integrated into a group of healthcare providers, with their work overseen by state regulators but not restricted by arbitrary doctor-to-nurse ratios or procedural rules. Such a move could help medical groups deliver care to more Californians and provide basic services at lower cost.
The drug bill (SB 598) by Sen.
Hill's measure would allow pharmacists to substitute a less-expensive biosimilar for a branded drug without consulting the patient's doctor if the
Supporters of the measure, including two big biotech companies and one generic drug maker, say the notification requirement would help doctors respond if a biosimilar caused an adverse reaction long after it was dispensed, as sometimes happens with biologic drugs. But the extra step could also cast a pall of suspicion over the new treatments, reducing the potential savings. And if the notification is so vital to safety, why require it for only a few years, and only in California?