Loren Bonner
Pharmacists all across the nation felt a boost when a law was passed in Maryland on May 3, 2023, allowing pharmacists in the state who are practicing within their scope of practice to be reimbursed by private and public health plans.
“This is acknowledgment of what we bring to the table as pharmacists,” said Jade Ranger, PharmD, co-owner of The Prescription Shoppe in Williamsburg, VA.
Maryland’s HB 1151/SB 678, which takes effect in October 2023, will allow pharmacists to bill for any service that is within their scope of practice that health care plans cover for other providers. For example, Maryland pharmacists had a scope of practice change that allowed them to prescribe nicotine replacement therapy, but without payment for services covered in the bill. Now with this recent legislation, pharmacists can bill for the counseling and screening involved for the nicotine replacement therapy service.
Maryland’s new law is unique in that language in the bill covers payment from commercial insurance, public insurance, nonprofit health plans, and children’s health insurance programs.
“It was truly vetted by the insurance administration to make implementation as smooth as possible,” said Aliyah Horton, executive director of the Maryland Pharmacists Association.
She said they were happy to receive support for the bill from physician practices and federally qualified health centers.
“They stated they could increase the use of pharmacist’s expertise in their practices and hire more pharmacists because there was a funding mechanism to cover their services,” Horton said. “This creates fantastic opportunities for new graduates, those seasoned in certain practice areas, and for ramping up implementation of scope of practice changes that have been advanced in recent years.”
Horton said relationships, communications, and data were key in getting the bill passed.
“Many of our members have relationships with legislators. The legislators know the role and impact specific pharmacists and pharmacies have in their communities,” she said. “Legislators are also keenly aware of the challenges pharmacies have with PBMs and reimbursements. This bill supports more access to pharmacists and creates a payment opportunity that is largely beyond the scope of PBMs. Our elected leaders do not want to lose more pharmacies in their communities.”
Besides this win for pharmacists in Maryland, this year has brought an abundance of legislative victories to pharmacists—and their patients—in many other states. Within these pages is a roundup of laws which advance pharmacists’ scope of practice and payment for services that have passed in states so far in 2023.
“There are so many clinical services pharmacists can bring into the fold,” said Ranger. “For so long it has always been pharmacists behind counters—and there is nothing wrong with that. It is just refreshing to see that we are moving beyond the counter. We need to continue the momentum.” ■
Nebraska
Nebraska’s LB 227 was adopted and codifies pharmacy technicians’ authority to administer vaccinations under the supervision of a pharmacist.
North Dakota
North Dakota’s HB 1095 was enacted and allows for the reimbursement of comprehensive medication management provided by pharmacists by health plans in the state.
Montana
Montana’s HB 710 was adopted and codifies pharmacy technicians’ authority to administer vaccinations under the supervision of a pharmacist. SB 112 was also recently signed into law in Montana and authorizes pharmacists to prescribe medications for conditions that do not require a new diagnosis, are minor and generally self-limiting, and can be diagnosed with a CLIA-waived test or are patient emergencies.
Wyoming
Wyoming’s SF 9 was signed into law and recognizes pharmacists as health care providers within the state’s Medicaid program. The new law also establishes a pathway for pharmacists to be reimbursed for their patient care services by the state’s Medicaid program.
Colorado
Colorado’s SB 162 makes numerous changes, including expanding pharmacy technicians’ scope of practice to perform point-of-care tests under the supervision of a pharmacist and expanding reimbursement options for pharmacists for the administration of vaccinations to patients under the age of 19 years by the state Medicaid program.
Nevada
Nevada’s AB 156 expands pharmacists’ scope of practice to assess, prescribe, and dispense drugs for medication assisted treatment. In addition, SB 161 expands coverage by health plans of pharmacist-prescribed hormonal contraceptives.
New Mexico
New Mexico’s SB 92 was signed into law and authorizes pharmacists to test and treat for flu, Group A Streptococcus, COVID-19, UTI, and other emerging public health threats via a statewide protocol. Additionally, pharmacists in New Mexico are authorized to prescribe HIV pre-/post-exposure prophylaxis (PrEP/PEP) via a statewide protocol.
Illinois
Illinois’ HB 559 authorizes pharmacists to test and treat for COVID-19, test for influenza, COVID-19, and other emerging and existing public health threats, and provides coverage for these services by health plans in the state. Additionally, the bill expands pharmacists’ authority to administer COVID-19 and flu vaccinations to patients 7 years and older.
The Illinois Department of Healthcare and Family Services, which administers the state’s Medicaid program, recently received approval from CMS to allow pharmacists to bill for services associated with the prescribing of HIV PrEP and PEP. CMS’ approval comes after the passage of HB 4430 in 2022, which expanded pharmacists’ ability to furnish HIV PrEP and PEP through a standing order and required coverage of these services by public and private health plans in the state.
Indiana
Indiana’s HB 1568 will allow pharmacists to prescribe and dispense hormonal contraceptives under a standing order and provides coverage for these services by the state Medicaid program.
Connecticut
A new law in Connecticut aims to improve access to birth control by allowing pharmacists to prescribe certain forms without requiring a doctor’s visit first. The law permits pharmacists to prescribe hormonal and emergency contraceptives after completing an accredited educational training program related to the prescribing of these contraceptives.
In addition, Connecticut’s SB1102 expands pharmacists’ authority to administer vaccinations and codifies pharmacy technicians’ authority to administer vaccinations under the supervision of a pharmacist. Additionally, the bill expands pharmacists’ authority to administer point-of-care tests and prescribe and dispense HIV PrEP and PEP.
Maine
Maine’s SP 158 will allow pharmacists to prescribe and dispense hormonal contraceptives to patients who previously have been issued a prescription for hormonal contraceptives.
Maine’s LD 1151/SP 478 expands pharmacists’ authority to administer vaccinations to patients ages 3 years and up. In addition, LD 1728/SP 692 updates state law to allow pharmacists to provide increased access to opioid antagonists other than naloxone.
New Hampshire
New Hampshire’s SB35 will expand the vaccinations pharmacists are able to administer to include immunizations for respiratory syncytial virus.
New Jersey
New Jersey Governor Phil Murphy recently signed into law SB 275, which authorizes pharmacists to prescribe self-administered hormonal contraception pursuant to a standing order in accordance with protocols established by the New Jersey Board of Pharmacy and the State Board of Medical Examiners. This adds New Jersey to the list of over 20 states that have either passed similar legislation or are in the process of implementing these services.
New York
New York’s A1060 will allow pharmacists to dispense hormonal contraceptives under a nonpatient specific order written by a physician or a certified nurse practitioner.
Vermont
Vermont’s H 305 was passed by the Vermont House and Senate. The bill made updates to specify pharmacists’ authority to test and treat for acute ailments and pharmacy technicians’ authority to administer vaccinations under the supervision of a pharmacist. Governor Phil Scott vetoed the bill on June 1, 2023, and the veto was overridden June 20, 2023.
Vermont’s S 37 will allow pharmacists to prescribe emergency contraceptives pursuant to a state protocol.
Arkansas
Arkansas passed HB 1007 which expands pharmacists’ authority to prescribe HIV PrEP/PEP via a statewide protocol.
Georgia
Georgia’s HB 440 was signed into law and expands pharmacists’ scope of practice to allow pharmacists to dispense glucagon pursuant to a prescriber protocol.
Georgia’s HB 416 was adopted and codifies pharmacy technicians’ authority to administer vaccinations under the supervision of a pharmacist.
North Carolina
CMS recently approved North Carolina Medicaid’s request to add pharmacists’ services related to prescribing COVID-19 therapeutics, including Paxlovid (Pfizer) prescribing. These services are covered beginning February 1, 2023, through at least 12 months after the end of the public health emergency.
Maryland
Maryland’s HB 693/SB 647 was signed into law and expands pharmacy technicians’ authority to administer certain vaccinations under the supervision of a pharmacist.
As described in the introduction of this story, Maryland’s HB 1151/SB 678 was signed into law and allows for the reimbursement of services provided by pharmacists practicing within their scope of practice by private and public health plans in the state.
Virginia
Virginia’s SB1538 was adopted and recognizes pharmacists as providers within the state Medicaid program and requires Medicaid to cover pharmacists’ patient care services.
Virginia’s SB948/HB2274 was signed into law and authorizes pharmacists to test and treat for group A Streptococcus, flu, COVID-19, and UTI via a statewide protocol.
PBM reform state by state
States have also been busy this year enacting legislation to reform PBMs and health plans. More than 18 states have done so since the beginning of 2023. Some recent examples as of June 26, 2023, include
- Louisiana’s HB 548 which will create protections from PBMs for contract pharmacies and covered entities in the 340B program.
- Nevada’s AB 434 which establishes protections for contract pharmacies and covered entities in the 340B program from discriminatory practices by PBMs.
- Oregon’s SB 608 which requires that the state Medicaid program conduct a survey every three years to determine the cost of dispensing and update dispensing fees based on the results of the survey.
- Texas’ HB 1647 which was recently signed into law and prohibits white bagging mandates by health plans and PBMs related to clinician-administered drugs.
Federal agencies, including CMS, as well as federal bills also seek to address PBM reform in various ways. Keep an eye on APhA’s Legislative and Regulatory Update newsletter for the latest. ■