Plain English Breakdown
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Reimbursement for Advanced Practice Pharmacist Services
This law requires Medi-Cal to pay advanced practice pharmacists the same rate as doctors and mandates private health plans to cover their services if they already cover similar care from other providers.
What This Bill Does
- Requires Medi-Cal reimbursement for advanced practice pharmacist services, including medication therapy management (MTM), to match the physician fee schedule instead of the previous 85% rate.
- Directs the Department of Health Care Services to create a payment method ensuring MTM payments go only to eligible advanced practice pharmacists or pharmacies providing certain specialty drug therapies.
- Requires health care service plans and disability insurers to pay enrolled advanced practice pharmacists if their coverage already pays for similar services from other licensed providers.
- States that no state reimbursement is required by this act for local agencies.
Who It Names or Affects
- Advanced practice pharmacists providing services in California
- Pharmacies dispensing specialty drugs to Medi-Cal patients
- Health care service plans and disability insurers regulated by the Department of Managed Health Care or Department of Insurance
- The State Department of Health Care Services
Terms To Know
- Advanced practice pharmacist
- A licensed pharmacist with extra training who performs specific clinical services.
- Medication therapy management (MTM)
- Services where a pharmacist reviews and manages a patient's drug treatments to improve health outcomes, often related to specialty drugs.
Limits and Unknowns
- The bill does not specify the exact dollar amounts or dates when these new payment rates will begin.
- Medi-Cal reimbursement rules depend on federal approval and existing benefit schedules.
- Payment by private insurers only applies if their plans already cover similar services from other licensed health care providers.