Empire Justice Testimony on the Regulations and Implementation Process for SafeRx Legislation

Good morning.  My name is Lisa Mendel and I am an attorney working in Empire Justice Center’s Albany office on immigration and domestic violence issues.  I am presenting this testimony today on behalf of my colleagues working in our Long Island office in Central Islip as well as our staff in Albany, White Plains and Rochester who work with immigrants on a regular basis.

The Empire Justice Center is a statewide support center for legal services programs and the clients they serve.  We provide research and training, act as an informational clearinghouse and provide litigation backup to local programs.  We also undertake impact litigation and engage in legislative and administrative advocacy.  We currently have staff attorneys specializing in public benefits (cash assistance, child care, food stamps and child support issues), Health and Medicaid, Supplemental Security Income (SSI) and Social Security Disability (SSD) benefits, public and subsidized housing, legal issues affecting low income immigrants, consumer law and domestic violence.

We sincerely appreciate the invitation and the unique opportunity to be here today to provide our recommendations for specific provisions we'd like to see in the upcoming SafeRX regulations.  Our active advocacy with regard to language access issues, including our participation in the National Language Access Advocates’ Network (Cheryl Keshner of the Long Island office), coupled with our health advocacy work assisting Medicaid and Medicare beneficiaries in accessing prescription drugs and other medically necessary services, has educated us on the critical importance of ensuring meaningful access for pharmacy consumers with Limited English Proficiency (LEP).

Our Long Island office has been particularly active in expanding protection and support for people with Limited English Proficiency.  Long Island, often thought to be a fairly homogeneous place, belies that characterization.  Recent Census data suggest that immigrants – documented and undocumented alike – make up 16% of the population of Long Island, and account for 17% of total economic output (Fiscal Policy Institute).  According to the 2010 US Census, approximately 13.5% of New York State’s total population is considered to be Limited English Proficient, and in Suffolk County as many as 120,000 residents and are considered to be LEP.  Our staff on Long Island recognized a serious unmet need and have become increasingly active on this issue.  Two of our staff members are among the founders of the Long Island Language Advocates Coalition (LILAC) and have played central roles in the work of the group, including reaching out to the courts, the police, social service and healthcare providers to ensure that people are not denied access to crucial services and benefits as a result of their language limitations.  LILAC has, from the beginning, been very supportive of the SafeRx legislation, and now urges the Board of Pharmacy to adopt regulations that most effectively carry out the important objectives of the law.   

There is a rich body of research to support the critical role of the pharmacy in helping consumers access their medications, understand what they are taking and guard against possible drug interactions.  It has been our experience as well that low-income consumers rely on their pharmacist as the gatekeeper between them and their medications.  Adopting improved LEP protections is good public policy and will further New York’s goal of better integrating care. 

Empire Justice Center strongly supports the recommendations of the SafeRX Coalition and urges the Board of Pharmacy to integrate them into the forthcoming regulations.  I will briefly comment on a few of these recommendations.

1)Pharmacy Primary Languages:  The proposal on the table would limit the languages for which assistance will be provided to those spoken by at least 1% of the general population.  We are concerned that this may deny assistance to substantial numbers of non-English speakers. 

We therefore support either (a) that language assistance be provided for all languages spoken by at least 1% of the LEP population in a region or, in the alternative, (b) that such assistance be provided to speakers of the top 6 or 7 non-English languages spoken throughout the state.

2)Mail Order Pharmacies:  SafeRx requires completion of a study and formal rulemaking process before mail order pharmacies will be required to provide interpretation and translation services to individuals filling prescriptions through mail orders.  This method of obtaining medication occupies an increasingly substantial segment of the pharmaceutical market.  Among those who benefit from mail order purchases are those who have difficulty getting around, including the elderly and disabled.  Those among this group who are also LEP are uniquely vulnerable in terms of their capacity to understand critical information about prescriptions, dosage and cautions.

We urge you here to commit to an accelerated study and review of existing systems and processes in place at mail order pharmacies, including efforts already underway to improve language services delivery.  In addition, we hope that the process will make sure to seek out the perspective of LEP consumers and patients.

3)Standardization:  Standardization of medication instructions helps reduce the problems associated with labeling because it incorporates evidence-based techniques that improve prescription readability and understanding.  The U.S. Pharmacopeial Convention (USP) is developing a new national standard for prescription labeling.

We recommend that some of the U. S. Pharmacopeial standards be adopted as a starting point to create more comprehensive label standardization regulations.  Once again, we urge you to seek input from key stakeholders, including consumer groups, advocates for special populations, pharmacists, physicians and other health care professionals.

4)Notification:   As providers of legal services, we are acutely aware of the importance of adequate, understandable notice as the first step in ensuring that people secure the benefit of their legal rights.  SafeRx requires the adoption of regulations pertaining to the size, style and placement of signs notifying patients of their right to language services in pharmacies.  Proper notification is essential to ensure that both patients and pharmacists are reminded of the availability of language assistance services.

We recommend that you (a) adopt a standard message regarding patients’ rights and translate that message into multiple languages, (b) require pharmacies to include a Pharmacy Customer Bill of Rights for Language Services on their websites and (c) require pharmacies to engage in broader outreach to inform LEP consumers of their rights to language assistance services.

5)Prescription Pads:  SafeRx requires the Department of Health to promulgate regulations modifying the official paper and electronic New York State prescription pad so that a prescriber may indicate (1) if a patient is LEP and, if so, (2) the patient’s preferred language.

We believe that this objective can best be accomplished if official paper prescription pads are required to include a box similar to the current dispense as written (DAW) box that a prescriber can initial or check if a patient is LEP.  A comparable check box should be required for prescribers using electronic prescription forms.  An additional line should be added to enable the prescriber to write in the patient’s preferred language.  A drop-down menu can be used for prescribers using electronic prescription forms.

Although we highlighted certain issues, I will again note that Empire Justice endorses all of the recommendations set forth by SafeRx Coalition. 

Thank you for the opportunity to testify here today.