Medical Marijuana in Iowa

Apr 12, 2019  | 27 min  | Ep 4631 | Podcast

Podcast

A lawyer and a pharmacist. Both legislators. Here to discuss the evolution of medical marijuana policies in Iowa on this edition of Iowa Press.

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Funding for Iowa Press was provided by Friends, the Iowa Public Television Foundation. The Associated General Contractors of Iowa, the public's partner in building Iowa's highway, bridge and municipal utility infrastructure. I'm a dad. I am a mom. I'm a kid. I'm a kid at heart. I'm a banker. I'm an Iowa banker. No matter who you are, there is an Iowa banker who is ready to help you get where you want to go. Iowa bankers, allowing you to discover the genuine difference of Iowa banks.    

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For decades Iowa Press has brought you politicians and newsmakers from across Iowa and beyond. Now celebrating more than 40 years of broadcast excellence on statewide Iowa Public Television, this is the Friday, April 12 edition of Iowa Press. Here is Kay Henderson. 

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Henderson: In 2014 the Iowa legislature passed a law that legalized possession of cannabis oil as treatment for chronic epilepsy. Fast forward five years later, the legislature is still discussing medical marijuana. We currently have licensed, state-licensed producers, growers and dispensers of medical marijuana products. The debate rages on as to how potent the marijuana product should be and who should qualify to receive it. Our two guests today are in the middle of that debate. John Forbes is a democrat. He is a pharmacist in Urbandale. He is also a member of the Iowa House of Representatives. Charles Schneider is a republican. He is an attorney from West Des Moines. He is President of the Iowa Senate. Welcome back to Iowa Press.

Thanks for having us on.

Thank you.

Henderson: Across the table we have Erin Murphy, the Des Moines Bureau Chief for Lee Enterprises Newspapers in Iowa and James Q. Lynch, Political Writer for the Cedar Rapids Gazette.

Lynch: Representative Forbes, I want to start with you. Kay talked about what has happened in five years. Kind of set the scene for us, what can Iowans get today in terms of medical marijuana? What can they use it for?

Forbes: Well, currently the law we have on the books allows access to medical cannabis but you have to, first of all, have a registration card allowing you to possess or get that medication from one of our five dispensaries here in the state of Iowa. The bill that we have currently covers about 10 different medical conditions here in the state of Iowa. My thoughts are that hopefully at some point in time we can expand that and allow more access to medical cannabis products for people here in our state.

Lynch: So it's a very restrictive program at this point?

Forbes: Yeah, I think, compared to some other states that have passed medical cannabis laws, I think Iowa's is probably one of the more restrictive right now. But we're working in a bipartisan way to try to expand those needs for Iowans and hopefully in the future we'll have more medical conditions covered under our current bill.

Murphy: So let's talk about that. There’s some proposals that have been made in the legislature this session. Senator Schneider, what are some of the ways that are being considered to expand this program and make it more available for more people or perhaps more potent for people who want to address their ailments? What is on the table right now?

Schneider: I think the bill that probably is most viable among those that have been introduced is the one that the House passed with nearly unanimous support a few weeks ago and sent over to the Senate. That bill cleared the judiciary committee before the funnel deadline of last week and I think really is the only remaining viable option. And what that bill does importantly I think is move away from a THC cap that is based on a percentage and move it toward a cap that is based on milligrams. So I think that makes sense because when you think about the medications that you take and even most of the supplements that people take when you look at the label it tells you how much active ingredient is there in terms of milligrams, not percentage. So when you take a Bayer, the label tells you how many milligrams of aspirin are in that Bayer, when you take an Advil the label tells you how many milligrams of ibuprofen are in that Advil. And what switching this cap from a percentage to a milligram based cap would do is more fully inform the consumer exactly what they're putting into their bodies.

Murphy: Representative Forbes, that bill passed your chamber. How did you feel about that proposal?

Forbes: Well I've always been in favor of taking the percentage cap off and moving to a milligram per dose basis. As Senator Charles Schneider just said, today most medications when you go to a pharmacy they're dispensed to you in a milligram per capsule basis or tablet basis. So I think having that in place gives more dosing options now for people who will go to the medical dispensaries and can then work with their physician when they get the recommendation letter and work with the people in the dispensary to find out or make sure they make the best recommendation on dosing for them.

Murphy: And when you talk to legislators who have concerns or hesitations about the program in general or maybe expanding it, you often hear concerns that the federal government should be playing a more prominent role in this, that the state should be deferring to the federal government or that legislators shouldn't be playing doctor, they should be deferring to the board of experts that was set up in addition to this program. I'm curious each of you, start with Representative Forbes, what are your thoughts on those concerns?

Forbes: Well, we did, in the bill that we passed in 2017, put together a medical cannabis board of medical practitioners. But I'd like to point out too in the Iowa legislature we have quite a few health care practitioners. We have two pharmacists, we have a physician, we have a dentist, we have a nurse practitioner and we have at least one nurse in both chambers. So we have the medical expertise I think in both chambers to make those decisions which are best for Iowans.

Murphy: Senator Schneider, should the state be deferring to the feds on this?

Schneider: I think ideally at some point I'd love to see the federal government reschedule marijuana as a schedule II drug as opposed to a schedule I drug. That would open it up for more research and ultimately what I would like to see is people be able to treat this just like any other medication, doctors be able to prescribe it just like any other medication, people to be able to go into John Forbes' pharmacy and buy it just like any other medication. And that I hope we can get to at some point, but the federal government hasn't acted, and we hear a clear outcry from our own constituents who want access to this for the different conditions that they themselves or their family members have. And at the end of the day we have to be responsive to our constituents and that is what we have done with the law that we have on the books now.

Lynch: So, the federal inaction aside, in Iowa for five years every year there has been a proposal to expand the uses and talk about the potency and those sorts of things. Is this just Iowans being cautious, Senator Schneider? Or are there other factors at play here, generational? There's a lot of people in the legislature who grew up with Just Say No. Is that part of the problem here?

Schneider: I don't know that there's really a problem. I would just say that this is part of a learning continuum. I myself had to get comfortable with this before helping to lead it through the Iowa Senate in 2014 and then again a stronger bill the year or two after that. And it was only after listening to my own constituents and friends who have family members with debilitating conditions who would have benefited from this that I finally got comfortable with it. And, again, because of federal inaction we've had to do what we can to respond to our constituents' demands, learn what we can and improve the program as time goes on and that is something that I think we owe it to Iowans to continue to do.

Lynch: Representative Forbes, you talked about the medical professionals in the legislature. Are you sort of teaching colleagues, bringing some of them up to speed on current knowledge of the benefits of medical cannabis or medical marijuana?

Forbes: Yes, I've had discussions with both republicans and democrats in the House on this and it's a step process in the House. As we like to say, we're taking baby steps. And we're trying to make sure that we don't do something that is going to harm Iowans. That is our main concern. We are here as public servants to make sure we protect the public. And we have to make sure we get it right. And so by working through this process in both chambers we're working on legislation that we can come together in a bipartisan way to make sure that Iowans have adequate treatment for medical cannabis products. Now, medical cannabis products are not first line therapy in most of the diseases that it treats. They are adjunct therapies when other drugs don't work. Physicians then can make that letter of recommendation to allow a patient to go into a medical cannabis dispensary and try some of these products. And I've heard from dozens of patients who have used these products and had very, very positive outcomes.

Murphy: Senator Schneider, in the proposal that you described one thing that I didn't hear, and fill in the blanks if you would, was the addition of any conditions that could be covered by the use of this product. Are there are in that proposal? And I know maybe more broadly there has been discussion that some legislators want to see even more conditions included in this program. What is and what isn't in that as far as adding conditions?

Schneider: From what I remember of the bill there is nothing in there that adds conditions. The board that we set up recommended including a certain type of autism but that wasn't included in the House bill. I don't think we will take that up in the Senate this year.

Murphy: What is the hesitancy, why not -- PTSD is another one that I hear a lot of people talk about that people would like to be able to treat that with this product -- what is the hang up there?

Schneider: And I'm only speaking for myself here but there are people on both sides of that issue. Some people say that THC is bad and can have ill effects for people who suffer from PTSD, whereas you also have people who say that it works for them. So I think like everything else with this program this is just part of a learning process and the people who are asking us to include PTSD just need to continue to educate legislators, educate members on the board that we have set up, to try and help us and them understand why it should be included.

Murphy: Representative Forbes, what else would you like to see as far as conditions covered by the program?

Forbes: Well, some states allow recommendations, they just allow that to physicians to make that determination what is best for the patient. Our bill that is in the House now has about 10 different medical conditions from cancer to ALS. One of the things we did in the House version that was sent over to the Senate is we did recognize that people that have terminal illnesses and want to use cannabis products, we did take that cap off and allowed them to use higher dosages and more milligrams to be able to treat their pain on end of life type symptoms. So we are hopeful that that will allow people who are terminally ill to access the product and use it more efficiently.

Lynch: In five years since the medical cannabis program was started in Iowa and now we have growers, producers, dispensaries, and one of the concerns has always been whether the industry is viable in Iowa. Senator Schneider, do we need more people using medical cannabis to make the industry viable? Or can it survive under the current regulations?

Schneider: One of the reasons we are moving from a percentage THC cap to a milligram THC cap is to help the producer who is here now produce a product that is more viable. And under the current set up of our program we also have another producer coming into the state right now to, they'll be online I think in June or July. So I think right now the program that we have is viable. But does that mean it's perfect? No. We do need to continue to refine it as we go along and I think we do want to make sure that the producers who invest in our state to provide this product to consumers are able to survive.

Henderson: There's also discussion about adding dispensaries, places where people can go to get the product, because there's a limited number now. Is that something that will happen down the road or might happen this year?

Schneider: I think it can happen down the road. It's not in the House bill that was sent over that I can recall. I'm certainly open to that and I think other legislators will be too as time goes on. But that's not a part of the bill that is actively under consideration this year.

Murphy: Senator Schneider, whether it is this bill or maybe more broader expansion in general, I'm wondering if the Governor has given you and your colleagues in the Senate any guidance or feedback. She is often cautious with us in members of the media when weighing in on legislation. Ultimately anything that gets to her desk obviously needs her signature for approval. Is she supportive of what is being worked on now in the House or maybe even broader expansion in general terms?

Schneider: I haven't had conversations with her personally about this issue. So one of the things on my to do list for next week is to visit with Senator Zaun who has been spearheading this effort in the Senate, see if he has had those conversations, and if not then of course we need to notify the Governor's Office about what the bill contains, answer any questions they have, and make sure that it's in a form that the Governor would feel comfortable signing if it were to land on her desk.

Henderson: Gentlemen, you're involved in a lot of issues at the legislature and let's move onto a few others. Senator Schneider, you are advocating a bill that would raise the age for purchasing tobacco products in Iowa. Why?

Schneider: Not just tobacco products, also e-cigarettes. The reason I'm doing that is because I'm hearing from more and more parents and more and more teachers and school administrators who say that vaping in particular is a real concern in their schools and it is becoming an epidemic. If you look at the statistics, usage of vaping products in high schools has I think almost doubled just within the last year. So what we need to do, in my opinion, is increase the minimum age for purchasing tobacco and e-cigarette products to make sure that no one who is in high school today can legally purchase them, bring them back to school and share them or sell them to their friends.

Henderson: There is also an interesting circumstance in that several of the health advocacy organizations are registered in opposition to the bill and they are asking lawmakers to consider raising the taxes on tobacco products and these electronic devices that deliver this pod of nicotine. Is that something that legislators might consider this year?

Schneider: Well, they can certainly advocate for that. The reason they say they want that is because they believe that's the only way that teens will really stop using those products. I've seen evidence to the contrary. There is a study by the Chicago Department of Health that showed that use of e-cigarettes among teens and people under the age of 18 decreased by I think it was 36% after the city of Chicago increased the minimum purchase age for tobacco and e-cigarette products. Senator Quirmbach shared some information with me about a suburb in Boston that did a similar thing, it increased the minimum age for purchasing tobacco and e-cigarette products and use of those products by teens and in their schools decreased after that happened too. So I'm not convinced that all of those things they are asking for have to happen in order for us to keep those products out of our schools.

Henderson: Also the state of Illinois now has a 21 law for purchasing those products.

Schneider: They just signed it, yeah.

Henderson: Does that put pressure on border areas?

Schneider: I don't know that it puts pressure. I think what it does is it shows that this is a trend states are moving toward. It's not just blue states like Illinois, red states also have been increasing the minimum age for purchasing tobacco and e-cigarette products. Governor DeWine in Ohio has made this a key part of his platform for this legislative session in Ohio. The Texas Senate just passed a law increasing the minimum purchase age and it is expected that the Texas House will follow suit and that the Governor will sign that.

Lynch: The House passed a Health and Human Services budget this past week and Representative Forbes, you had an amendment that was accepted calling for an audit of pharmacy benefit mangers. You used the term that sort of an experiment you ran with your pharmacy the numbers were disturbing. Tell us more about that and what you hope to accomplish through this audit.

Forbes: Well, where we got started is last April we were notified from Wapello County from people they were having issues with their prescription drug program through the county employees. So we did an audit with that program and we held a House government oversight committee meeting I think last April 20th and found out there's very disturbing pricing differences within different programs in the PBM industry. And in some cases we found, in this case with Wapello County, where pharmacies were being reimbursed about $10 per prescription but the county was being billed over $125 for that same prescription and that is what we call spread pricing. And so after that meeting I had members from both chambers ask me to look into our state Medicaid program. And so I worked with Director Randall, who is the Director of the Iowa Medicaid program, he was able to provide me with some data from my pharmacy. So I compared what I was paid, and pharmacies in the state of Iowa under our state Medicaid program are paid correctly. But what I found that was disturbing was in some cases the state was being billed three to four times the amount that pharmacies were reimbursed. So that prompted me then to work in a bipartisan way in the House to put together a program where we're going to go out and audit the PBM industry here in the state of Iowa in reference to our state Medicaid program.

Lynch: Senator Schneider, is this similar to the bill the Senate passed calling for an audit, I think it was more specific and maybe broader? Is this something where there is sort of a shared goal of both chambers to get to the bottom of this?

Schneider: I think so. I think both chambers want to shine a light on kind of the opaque process for what prescription drugs actually cost and PBM's play a significant role in that. They are the third party administrators for a lot of different health plans, they negotiate with drug companies to determine which drugs and how much those drugs will cost will be included in plans, and that leaves the consumer really not knowing exactly how much drugs cost. And the more consumers know about it, the more the public knows about it, the more the planned sponsors themselves know about it, the better able they will be to pressure drug companies to lower costs and make it more affordable for everyone.

Forbes: The state of Ohio did an audit of their state Medicaid prescription drug program last year and found out that they were overbilled over $224 million and that is what prompted us in the state of Iowa to look at our program here and hopefully we'll have our audit results back sometime later this year.

Murphy: Senator Schneider, we want to talk about the ongoing issues with flooding, especially in the western part of the state. Governor Reynolds started her weekend by meeting with Vice President Pence in one of the areas hit hardest over there. Is there potentially a role for legislators to play yet this session, which may be winding down by the end of this month, in helping in that response efforts whether it is some additional funds out of the emergency funds or whatever it might be? Leaders have said they are deferring to the Governor for her leadership on this so far but I know there have been discussions about possible legislative action. What can you tell us about what may happen here?

Schneider: We have had conversations with the Governor's Office. She has reached out to us and she has been really at the forefront of leading the charge on this issue to make sure that we're helping Iowans in need. And I would expect that she unveils a plan sometime early next week. The really frustrating part in all of this for me and for a lot of people in our caucus is that the federal government has done nothing yet and we see all these democratic Senators coming in here to campaign for president week after week and yet they haven't answered, I have not heard anyone ask them from the media or otherwise ask them why they voted against flood relief. Maybe they have and I just didn't see it. But it's frustrating to me that they haven't done anything. And that has kind of held us up to figure out what we need to do because we need to know what the federal government is going to do before we know what we need to do as a back stop.

Murphy: Well, and for the benefit of the viewers, part of the hang up over that federal relief is aid for Puerto Rico and how that fits into the package --

Schneider: That's what they have said, yeah, but I don't know why they couldn't do that in a separate bill.

Murphy: Right. I've wanted to ask you because you touched on, there's the challenge with the lack of federal action, and then isn't there also a challenge of this is still an active problem, the waters still haven't receded in a lot of areas, are we going to have a big enough picture of the issue before legislators are done to know what needs to be tackled before legislators are gone for the summer?

Schneider: We may not. We'll have as much information as we possible can of course and I think what we will do, what we'd like to do is give the Governor enough leverage to do what she needs to do in order to manage circumstances as and if they change.

Lynch: Let's go from floods to sunshine. There's a bill working its way through the legislature, some people refer to it as the solar tax, other people call it the grid equity fee. Representative Forbes, you have solar panels on your pharmacy, you would have to pay this fee or tax. If it passes, it has passed the Senate, it's in the House, is it going to pass the House? Are the votes there?

Forbes: Well, first of all, with the panels I currently have on my building I'm grandfathered in so I won't have to pay the tax. But new installations, if this bill does move forward, will have to pay that. When I did the calculations on my business, if I were to put those panels in say next, in the fall if this bill did pass, my payback would go from eight years, which it currently is, to fourteen years. And so in that case I have to make a business decision whether I would have even wanted to invest in that because I invested about $100,000 into my business to bring that. The bill is currently in the House. I know there's a lot of discussion on both sides. I don't know where we're at. I've heard that the republican caucus is short a few votes to pass the bill. But we're hopeful that we can, I don't see that bill come to the floor of the House this year.

Murphy: Senator Schneider, one of the Governor's main agenda items this year that did not survive the funnel that you alluded to recently was a proposal to reinstate felon's voting rights through a proposed constitutional amendment. Looking forward now on that because the Governor said she's still going to push for that, is there a point where, and Senate republicans especially because that was where many of the concerns were raised among that caucus, where there can be enough agreement on the restitution items that this can come together? Or is there too many hurdles in place to get to where everybody can agree that this is appropriate to do? Maybe add some safeguards but doesn't make it so restrictive that it defeats the purpose of the goal in the first place?

Schneider: I think there's a way to get this done. And the important thing to remember about this process too is that the bill has to pass both chambers and be signed by the Governor some time within the first general assembly and the succeeding general assembly. Each general assembly is two years. So we've got another year to work on it. I think everyone is in agreement that it is good that people who have served their sentences, paid their restitution and done their time want to get reintegrated into society. I think most people recognize that it's probably better that we set up some kind of framework for people to have their voting rights restored rather than to leave it up to the whims of whoever happens to be in the Governor's Office. So I'm hopeful and optimistic that we'll be able to get something done on this.

Henderson: Gentlemen, thanks so much for being on this episode of Iowa Press and sharing your views. And to you listeners and viewers at home, thanks for joining us today. Join us again next week at our regular times, Friday evening at 7:30 and Sunday at Noon. For everyone at Iowa Public Television, thanks for joining us today.

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Funding for Iowa Press was provided by Friends, the Iowa Public Television Foundation. The Associated General Contractors of Iowa, the public's partner in building Iowa's highway, bridge and municipal utility infrastructure. I'm a dad. I am a mom. I'm a kid. I'm a kid at heart. I'm a banker. I'm an Iowa banker. No matter who you are, there is an Iowa banker who is ready to help you get where you want to go. Iowa bankers, allowing you to discover the genuine difference of Iowa banks.    

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