Increase Access to Pharmacy Services

Plain English Breakdown

The official summary states the state board of pharmacy must adopt rules for final product verification by December 31, 2026; specific operational details depend on these future rules.

HB26-1336: Increasing Access to Pharmacy Services

This law requires health insurance plans and Medicaid to pay for pharmacist services within their scope of practice without needing special agreements, allows technicians to verify certain medications under supervision, and lets pharmacists prescribe medicine to children aged 5 through 11.

What This Bill Does

• Requires health benefit plans providing medical expense coverage to reimburse pharmacists for covered services within their scope of practice without requiring a collaborative pharmacy practice agreement.
• Authorizes Medicaid reimbursement for pharmacist services that are not duplicative of other reimbursed programs or services.
• Prohibits insurance companies from discriminating against licensed pharmacists based solely on license type regarding network participation, referrals, or payment, while still allowing plans to set quality standards and limit networks as needed.
• Allows supervising pharmacists to delegate final product verification for non-controlled substances to certified pharmacy technicians or interns if the pharmacy has a continuous quality assessment system in place.
• Expands pharmacist authority to prescribe drugs or devices without controlled substance status to patients aged 5 through 11 for minor, self-limiting conditions that do not require a new diagnosis.

Who It Names or Affects

• Health benefit plans and insurance companies providing hospital, surgical, or medical expense coverage.
• Pharmacists licensed under state law to perform clinical services or prescribe medication.
• Certified pharmacy technicians and interns working in pharmacies with a quality assessment system.
• Patients aged 5 years old or older but younger than 12 receiving treatment for minor conditions.

Terms To Know

Scope of practice

The specific services a pharmacist is legally allowed to perform based on their license and training under state law.

Final product verification

A final check to ensure the correct drug, device, or product was prepared for a patient before it leaves the pharmacy.

Collaborative pharmacy practice agreement

A formal contract between a pharmacist and another healthcare provider that is no longer required by this law for certain services to be reimbursed.

Limits and Unknowns

• The law does not require insurance plans to cover any health-care service they do not already cover under their existing policies.
• Pharmacists must notify a patient's primary care provider if the pharmacist tests or treats anyone younger than 18 years old, unless no such provider is known.

Official Summary Text

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.)