Pharmacists as ProvidersRecognition and reimbursement for pharmacist-provided patient care services remain a top priority for TPA and the entire pharmacy profession. TPA continues to advocate for formal recognition, at the state and federal levels, for the important role of pharmacists as members of the patient’s health care team.State-Level: Pharmacist Credentialing as Providers - Legislation: HB 0405 / SB 0461
- House Sponsor(s): Terry, Sexton C
- Senate Sponsor(s): Bell, Haile
- Description: As introduced, expands current code to include pharmacists in the list of classes of providers which managed health insurance issuers are prohibited from discriminating against as providers in medical networks, with respect to participation, referral, reimbursement of covered services or indemnification, solely on the basis of their license or certification, if such providers are acting within the scope of their license or certification.
- What This Legislation Is Intended to Do:
- This legislation will add “pharmacists” as providers of care in existing state insurance code (TCA 56-32-129).
- This legislation will provide a pathway for pharmacists who are acting within the scope of their license or certification under state law to be credentialed with managed health insurance issuers and enable them to participate, receive referrals, and be reimbursed for covered services or indemnification.
- This legislation will create a mechanism for pharmacists to participate as members of the larger health care team, resulting in increased communication, collaboration, and patient referrals, as appropriate, to physicians and other health care providers for further assessment, management, and treatment.
Federal Level: Pharmacy and Medically Underserved Areas Enhancement Act - Legislation: H.R. 592 / S. 109
- House Sponsor(s) from TN: Roe, Duncan, DesJarlais, Blackburn, Cohen
- Senate Sponsor(s) from TN: None
- Description: As introduced, this legislation amends section 1861(s)(2) of the Social Security Act to recognize pharmacists’ services within Medicare Part B.
- What This Legislation Is Intended to Do:
- Provide pharmacists with recognition under the Social Security Act and Medicare coverage for services furnished by a pharmacist, as licensed by State law, individually or on behalf of a pharmacy provider. The services are limited to:
- Services which the pharmacist is legally authorized to perform in the State in which the individual performs such services;
- Services as would otherwise be covered under this part if furnished by a physician, or as incident to a physician’s service; and,
- A setting located in a health professional shortage area, medically underserved area, or medically underserved population.
- Provide reimbursement for pharmacists which is equal to 80 percent of the lesser of the actual charge or 85 percent of the fee schedule amount provided under section 1848 if such services had been furnished by a physician.
Pharmacy Benefits Manager Oversight and DIR Restrictions Transparency and accountability for pharmacy benefits managers (PBMs) remains an ongoing top priority for pharmacy and TPA. TPA and key pharmacy stakeholders continue to educate legislators regarding PBM-related activities, such as direct and indirect remuneration (DIR), maximum allowable costs (MAC), and other issues which directly affect pharmacists, patients, and pharmacy operations. Direct and Indirect Remuneration (DIR) Restrictions and Pharmacy Benefits Managers (PBM) Registration - Legislation: HB 0569 / SB 0392
- House Sponsor(s): Powers, Sexton C
- Senate Sponsor(s): Haile, Dickerson
- Description: As introduced, prohibits certain direct and indirect charges to a pharmacist by a pharmacy benefits manager (PBM) or a health insurance entity; requires PBMs and auditing entities to make certain registrations.
PBM Ownership - Legislation: HB 0327 / SB 0397
- House Sponsor(s): Johnson
- Senate Sponsor(s): Haile
- Description: As introduced, under certain circumstances, prohibits the state from entering into, or renewing, a contract with a pharmacy benefits manager where the pharmacy benefits manager has an ownership interest in a pharmacy in its network, or the pharmacy has an ownership interest in the pharmacy benefits manager.
Professional Privilege Tax Repeal or Reduction Since 2016, TPA has been one of the members in a growing coalition of providers affected by this tax, who are working together to pursue repeal or reduction of the professional privilege tax. - Legislation: HB 0041 / SB 0132 / (5-Year Repeal)
- Other Legislation: 6 additional bills filed
- House Sponsor(s): VanHuss, Matlock, White D, Lynn, Casada, Goins, Butt, Hulsey, Hill M
- Senate Sponsor(s): Bowling, Lundberg, Kyle, Gresham, Gardenhire, Watson, Johnson, Beavers, Southerland, Niceley, Norris, Massey, Bailey, Yager, Kelsey, Briggs, Green, Hensley, Ketron
- Description: As introduced, phases out the professional privilege tax over a five-year period for tax years that begin on and after June 1, 2017. Click on THIS LINK to view the Tennessee Advisory Commission on Intergovernmental Relations (TACIR) study regarding the professional privilege tax in Tennessee.
Drug Donation Program TPA is working with sponsors on this authorizing legislation, which allows the Tennessee Board of Pharmacy to establish and maintain a prescription drug donation repository program under which any person may donate prescription drugs and supplies for use by individuals who meet eligibility criteria. - Legislation: HB 0137 / SB 0429
- House Sponsor(s): Sexton C
- Senate Sponsor(s): Kelsey
- Description: As introduced, establishes a prescription drug donation repository program.
Medication Therapy Management (MTM) in Medicaid The TPA-supported MTM in Medicaid legislative effort in 2016 resulted in the formation of a TennCare MTM Technical Advisory Group (TAG). This MTM TAG continues to meet and provide input to TennCare regarding the integration of pharmacist-provided MTM services into its benefit design for its beneficiaries. Efforts are ongoing and TPA anticipates that members will again have an opportunity to engage with legislators on MTM in Medicaid during the 2017 legislative session. - Legislation: HB 0628 / SB 0398
- House Sponsor(s): Kumar
- Senate Sponsor(s): Haile
- Description: As introduced, requires the Bureau of TennCare to report to the Senate Health and Welfare Committee and the Health Committee of the House of Representatives concerning the effects of incorporating medication therapy management into its healthcare delivery systems by January 15, 2018.
Medication Synchronization Pharmacy stakeholders, including TPA, continue to support pharmacists’ role in medication synchronization activities which increase medication adherence and promote proper utilization of medication therapies, leading to higher quality patient health outcomes and quality of care. Many pharmacists have provided medication synchronization services to patients in Tennessee for years, and these activities have produced higher adherence rates and better health outcomes for patients. - Legislation: HB 0139 / SB 0799
- House Sponsor(s): Sexton C
- Senate Sponsor(s): Dickerson
- Description: As introduced, prohibits health insurance policies from using prorated dispensing fees or denying coverage for dispensing of medication in accordance with the synchronization of medication; and requires health insurance policies to apply prorated cost-sharing to dispensing of medication in accordance with synchronization of medication.
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