The Wyoming House of Representatives wants doctors to have a lot of latitude in prescribing medications to treat COVID-19.
The Senate Labor, Health and Social Services Committee wrestled with House Bill 119 on Wednesday morning, which would authorize Wyoming physicians to prescribe off-label medications.
This practice of prescribing a drug for a different purpose that what the Federal Drug Administration has approved it for is already generally accepted for non-Medicaid patients in Wyoming.
But state Rep. Sarah Penn, R-Riverton, who is the lead sponsor of HB 119, said since the beginning of the COVID-19 pandemic, more pressure has been put on providers to do otherwise when treating the virus.
“We have a need to protect and preserve the integrity of the practice of medicine,” Penn said, adding that overall, about 20-30% of all prescriptions are for off-label medicine.
COVID-19
Penn said many Wyoming doctors were warned against treating COVID with off-label medications and sometimes had their discretion taken away altogether.
“They were worried about the risk of license and risk of livelihood,” she said.
Although Penn said no providers actually lost their medical licenses, certain providers were fired for prescribing them. She also said the Wyoming Medical Board warned against using hydroxychloroquine for treating COVID, saying it would violate the state’s Medical Practice Act.
The Federation of State Medical Boards, of which Wyoming is a member, also issued a statement in July 2021 warning that spreading misinformation and disinformation about effective treatments for COVID could risk disciplinary action.
“We have a situation where the threat of discipline in many cases was as effective as the discipline itself,” Penn said. “I truly believe lives were lost. The excuse that was used is we can’t use it because it’s off-label. These medications have been around for 35 years and over the counter in many countries.”
Not A Free Pass
Penn said her bill would not prevent medical boards from taking action against a doctor for negligence.
During the pandemic, there was an intense focus placed on what medications could and could not effectively fight the virus.
Hydroxychloroquine and ivermectin, which both have FDA approval for treating certain illnesses, were promoted by many as viable options for treating COVID.
“We have the opportunity to learn from the events of the last couple years,” Penn said. “We need to be prepared for what may come next.”
According to the medical journal The Lancet, 247 mostly small clinical trials were launched in spring 2020 to evaluate if hydroxychloroquine could prevent or treat COVID.
The medication was endorsed by a handful of influential and polarizing sources but failed to show notable protection against the virus, leading the Federal Drug Administration to revoke its emergency use authorization for the drug in treating the virus.
The New England Journal of Medicine reported in 2022 that 60 randomized trials of ivermectin for the treatment of COVID have been registered, with results inconsistent. Some have advocated for benefits of ivermectin and others have been inconclusive.
Penn’s bill would apply to prescriptions for all Wyoming residents, a feature Stefan Johansson, director of the Wyoming Department of Health, took issue with. He mentioned that Medicaid does not allow off-label prescriptions for its patients.
Department Of Health
“Specific to Medicaid, our ability to authorize Medicaid funds could be challenged,” Johansson said. “It could put us at risk for non-compliance.”
A similar argument was brought by the WDH when speaking against legislation that would have prohibited any facility in Wyoming from enforcing a vaccine or facemask requirement.
Johansson also said he’s concerned the legislation would lead to many more off-label prescriptions in Wyoming, which would increase the workload on his staff.
The Department of Health has to grant prior authorization for all off-label use of medication in the state.
Cori Cooper, Medicaid pharmacy program manager for the Wyoming Department of Health, said two of her employees authorized about 15,000 off-label prescriptions in 2022.
“Their administrative burden would get longer, we would have to hire more staff,” she said.
Sen. Anthony Bouchard, R-Cheyenne, disagreed.
“I don’t see doctors running out there saying, ‘Let me give rat poison to cure a disease,’” he said.
Not A Perfect Track Record
Penn said doctors should be trusted to issue appropriate prescriptions to their patients, but giving drugs to treat conditions they weren’t originally intended for doesn’t have a perfect record.
Cooper mentioned how naltrexone has been used by some doctors in other states for COVID despite some research showing it doesn’t improve the core characteristics of the disease.
“I use that as an example because if it’s not on-label and not permitted, it is considered experimental,” she said.
Matt Martineau, executive director of the Wyoming State Board of Pharmacy, also expressed concern that House Bill 119 would create a larger gray area as to what prescription orders pharmacists should and should not fill.
“When you’re talking about affecting prescriptions, a pendulum is brought up,” he said. “Even small touches to that pendulum can cause wide swings in what is happening.”
Conflicts of Interest?
Penn is a nurse practitioner at the Lander Medical Clinic, a facility that could stand to benefit from HB 119 with an expanded environment for off-label prescriptions.
The Wyoming Constitution states that members of the Legislature who have a personal or private interest in any measure or bill proposed or pending before the body must disclose it and not vote on those bills.
Penn did not mention her occupation while presenting her bill Wednesday morning or recuse herself from voting on it when it was debated in a House committee Jan. 30.
Other legislators who work in health care also have brought and voted for legislation that would benefit their occupations this session.
Earlier this month, Cheyenne Republican Reps. Dan Zwonitzer and Landon Brown brought a $200,000 amendment to the House supplemental budget bill for a study on the Program of All Inclusive Care for the elderly. This now-defunct program was used by their employer, Cheyenne Regional Medical Center. Both voted in favor of the amendment.
While discussing bills she said would protect local rodeos, Rep. Rachel Rodriguez Williams, R-Cody, disclosed during Wednesday’s discussion that her husband is a judge for the Cody Nite Rodeo, but did not recuse herself from voting.
Rep. Jon Conrad, R-Mountain View, is the the Environmental and Governmental Affairs manager for Tata Chemicals in Green River and serves on the House Minerals, Business and Economic Development Committee.
Penn told Cowboy State Daily she was inspired by her constituents to bring the off-label medication bill.
“We had a situation where one narrative was allowed and another narrative wasn’t and people should have at least had the ability to investigate for themselves or try for themselves in a situation where it was safe and certain medications were villainized,” she said. “Therefore, their access was cut and other medications which had equal amounts of research with regards to treatment of COVID, they were put out there as being the protocol of the treatment and they’re safe and effective.”
HB 119 passed through the House on a 44-18 vote on Feb. 2.
The Senate Labor Committee will continue discussing the bill Friday morning.
