Increase Access to Pharmacy Services

     If certain conditions are met, the act requires health benefit plans that provide hospital, surgical, or medical expense insurance to provide reimbursement for health-care services provided by a pharmacist that are within the pharmacist's scope of practice without entering into a collaborative pharmacy practice agreement. Similarly, under the medical assistance program (medicaid), the act authorizes reimbursement for services that are within a pharmacist's scope of practice and not duplicative of other pharmacist services or programs reimbursed by medicaid.

     Further, solely on the basis of the type of license or certification, a health benefit plan or health insurance company (carrier) shall not discriminate against a pharmacist who is acting within the scope of the pharmacist's license or certification under state law, with respect to participation, referral, reimbursement of covered services, or indemnification, or prohibit a pharmacist from membership in a provider network; except that, in selecting pharmacist providers, the act does not:

• Prohibit a health benefit plan or carrier from including providers in its provider network only to the extent necessary to meet the needs of the plan or from limiting referrals or establishing quality control measures;
• Require a health benefit plan or carrier to contract with any provider willing to abide by the terms and conditions for participation established by the health benefit plan or carrier; or
• Require coverage for any health-care service that is not otherwise covered.

     The act makes changes to the definitions in the pharmacy practice statutes to include a definition for 'final product verification'. For drug, device, or product orders that are not for controlled substances, final product verification may be delegated by a supervising pharmacist to a certified pharmacy technician or pharmacy intern. A pharmacy or other outlet shall have a continuous quality assessment system in place to periodically verify the accuracy of the final drug, device, or product and must create a plan for final product verification, including how pharmacists' hours will be maintained to provide direct patient care. The state board of pharmacy is required to adopt rules relating to final product verification no later than December 31, 2026.

     Under current law, a pharmacist may administer certain tests to patients who are 12 years old or older for certain conditions and prescribe drugs to treat the tested conditions. The act adds to the definition of the 'practice of pharmacy' independent prescriptive authority for drugs that are not controlled substances, drug categories, or devices that are prescribed to patients who are 5 years old or older but under 12 years old for conditions that do not require a new diagnosis, that are minor and self-limiting, or that have a test that guides diagnosis and are not medications that may only be prescribed pursuant to a certified education program and a limited distribution network. If a pharmacist tests or treats any patient who is under 18 years old, the act requires a pharmacist to notify the patient's primary care provider consistent with health-care privacy laws or, if the patient does not have or disclose a primary care provider, refer the patient to a primary care provider for further care.


(Note: This summary applies to this bill as enacted.)