The ASCP government affairs staff is tracking new bills in several state legislatures aimed at establishing or expanding insurer coverage of pharmacist services over and above medication dispensing.
The Missouri legislature is considering a bill that would require Medicaid to pay for professional pharmacy services as well as dispensing services. The bill (H.B.497) calls for the state Medicaid agency to set fees that meet or exceed the cost to the pharmacy of providing those services. All insurance plans offering pharmaceutical services would be required to meet or exceed Medicaid payment levels for the same services.
In Nebraska, a bill (L.B.413) working its way through the legislature calls for the addition of nondispensing pharmacy services to the list of services insurers must provide to be eligible for total or partial reimbursement.
New Mexico ASCP member John Heaton, who was elected to his state legislature last November, has put forth a bill that would establish broad insurance coverage of cognitive services. Under the legislation (H.B.527), all health care plans and pharmaceutical care plans that cover services within the scope of pharmacy practice would be able to pay or reimburse the cost of pharmacist services, including counseling on prescription drugs.
In Tennessee, legislation introduced in the state Senate (S.B.1060) and House of Delegates (H.B.701) calls for establishment of insurance reimbursement for pharmacists who provide outpatient self-management training, including medical nutritional therapy services.
ASCP's government affairs staff will track these bills as they advance, with an eye toward providing documentation or lobbying support to facilitate their enactment.
HMO Disclosure Bill Introduced in California
A movement is afoot in the California legislature to pass a law requiring managed care organizations to give enrollees information on financial incentives that enter into prescription coverage policies.
Under a bill introduced in the state Senate, managed care enrollees would be able to find out why HMOs limit access to certain higher-priced drugs while recommending cheaper alternatives.
The bill was introduced by Senate Insurance Committee Chairman Herschel Rosenthal, who commented in a news report, "There is no question in my mind that HMOs have gone too far to limit access to drugs to cut costs. [This practice] may result in longer illness, more doctor visits, and higher bills."
Under the legislation, managed care organizations would be required to:
Minnesota's Unusual Drug Pricing Initiative
The 1997 legislative season has produced a bevy of drug pricing bills, most of them designed to prohibit manufacturers from offering volume discounts based on class of trade. In Minnesota, however, a lawmaker has proposed a radical new approach to leveling the drug pricing playing field. State Delegate David Gubow has put forth a bill calling for the state to create and administer a non-governmental contracting alliance that would negotiate prescription contracts with drug makers and offer negotiated prices to all pharmacies.
Under the legislation, pharmacies purchasing drugs at the negotiated
contract price would be required to pass along to consumers at
least 75 percent of the resultant cost savings.