HB 1336 — Increase Access to Pharmacy Services

SecondNOTE: Regular Session Seventy-fifth General Assembly STATE OF COLORADO REREVISED This Version Includes All Amendments Adopted in the Second House LLS NO.

26-0863.01This Britabill Darlinghas x2241been HOUSEprepared BILLfor 26-1336the HOUSEsignatures SPONSORSHIPof Lindsaythe andappropriate Winterlegislative T.,officers Boesenecker,and Brown,the Clifford,Governor. Duran, Goldstein, Gonzalez R., Johnson, Marshall, McCluskie, McCormick, Nguyen, Rydin, Smith, Stewart K.

SENATETo SPONSORSHIPdetermine Peltonwhether R.the Governor has signed the bill or taken other action on it, please consult the legislative status sheet, the legislative history, or the Session Laws.

andHOUSE Cutter, Ball, Bright, Carson, Catlin, Coleman, Exum, Gonzales J., Jodeh, Kipp, Kolker, Marchman, Roberts, Snyder, Wallace, Weissman d d e m 2 T n 2 A U , E i y House Committees Senate Committees S a a Health & Human Services Health & Human Services e M d A BILL FOR26-1336 ANBYREPRESENTATIVE(S)LindsayandWinterT., ACTBoesenecker,Brown, iClifford, aDuran, CGoldstein, ONCERNINGGonzalez MEASURESR., TOJohnson, INCREASEMarshall, ACCESSMcCormick, TONguyen, PHARMACYRydin, eSmith, 2Stewart TK., dMcCluskie, 20Bacon, NBarron, 2Caldwell, 5Mauro, SERVICESPaschal, .Rutinel, Soper;

Ealso dSENATOR(S) yPelton SR. d M e Bill Summary m A (Note:

This summary applies to this bill as introduced and doesCutter, notreflectanyamendmentsthatmaybesubsequentlyadopted.IfthisbillBall, dBright, dCarson, passesCatlin, thirdExum, readingGonzales inJ., theJodeh, houseKipp, ofKolker, introduction,Marchman, aRoberts, billSnyder, summaryWallace, thatWeissman, eColeman. 2 applies to the reengrossed version of this bill will be available at E a 0 S U , http://leg.colorado.gov.) O n 2 H a r e A Undercurrentlaw,apharmacistmayreceivereimbursementunder r ahealthbenefitplanandunderthemedicalassistanceprogram(medicaid) 3 for health-care services provided pursuant to a collaborative pharmacy practice agreement.

IfCONCERNING certainMEASURES conditionsTO areINCREASE met,ACCESS theTO billPHARMACY requiresSERVICES health. g benefitplansthatprovidehospital,surgical,ormedicalexpenseinsurance i 6 toprovidecoverageforhealth-careservicesprovidedbyapharmacistthat a 0 S R , U d 2 H 2 r Shading denotes HOUSE amendment.

Double underlining denotes SENATE amendment.

e Ap Capital letters or bold & italic numbers indicate new material to be added to existing law.n Dashes through the words or numbers indicate deletions from existing law.

e A are within the pharmacist's scope of practice.

Similarly, under medicaid, the bill 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 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's network.

Thebillmakeschangestothedefinitionsinthepharmacypractice statutes to include a definition for "final product verification", which is defined as a physical verification process for drug, device, or product orders filled through a pharmacy's electronic system after initial fill by a technicianorotherautomatedtechnology.Finalproductverificationmay be delegated by a supervising pharmacist to a certified pharmacy technician or pharmacyintern.

The process requires a pharmacyor other outlet to have a continuous quality assessment system in place to periodically verify the accuracy of the final drug, device, or product.

A pharmacy intending to implement a final product verification program shall create a plan for final product verification, including how pharmacists' hours will be maintained to provide direct patient care.

The stateboardofpharmacyisrequiredtoadoptrulesrelatingtofinalproduct verification.

Under current law, a pharmacist has independent prescriptive authorityfor drugs that are not controlled substances, drug categories, or devices that are prescribed to patients who are at least 12 years old, if certain conditions are met.

The bill also adds to the definition of the "practice of pharmacy" to include independent prescriptive authorityfor drugs that are not controlled substances, drug categories, or devices that areprescribedtopatientsyoungerthan12yearsoldforconditionsthatdo notrequireanewdiagnosis,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.

SECTIONSECTION1. 1.

InInColoradoRevised ColoradoStatutes,10-16-144,amend(1) Revised Statutes, 10-16-144, amend (1) introductory portion, (1)(a), and (2) as follows:

(1) Any A health benefit plan, except supplemental policies -2-coveringaspecifieddiseaseorotherlimitedbenefit,thatprovideshospital, 1336 covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance maySTmay MUST provide coverage for health-care services under a specific treatment protocol provided by a pharmacist if:

(a)Capital Thepharmacistletters meetsor therequirementsinpart6ofbold article280& ofitalic titlenumbers 12indicate PROVIDINGnew SERVICESmaterial THATadded AREto WITHINexisting THElaw; PHARMACIST S SCOPE OF PRACTICE UNDER ARTICLE 280OF TITLE12;

(2)dashes (a)through Awords healthor benefitnumbers planindicate describeddeletions infrom subsectionexisting (1)law ofand thissuch sectionmaterial shallis providenot coveragepart forof health-carethe servicesact. provided by a pharmacist within a health professional shortage area, as defined in 42 U.S.C.

sec.(a) The pharmacist meets the requirements in part 6 of article 280 of title 1IS PROVIDING SERVICES THAT ARE WITHIN THE PHARMACIST S SCOPE OF PRACTICE UNDER ARTICLE 280 OF TITLE12;

254e,(2) if(a) theA conditionshealth specifiedbenefit plan described in subsection (1) of this section shall provide coverage for health-care services provided by a pharmacist within a health professional shortage area, as defined in 42 U.S.C.sec.254e,iftheconditionsspecifiedinsubsection(1)ofthissection are met.

(b)(a) ThisThissubsection(2)doesnotrequireacarriertocontractwith subsectionIFapharmacyorpharmacist (2)ISwilling does not require a carrier to contract withIF a pharmacy or pharmacistISwilling to abide bybythe the terms and conditions for participation established bybythehealthbenefit the health benefit plan or carrier,HEALTHcarrier, BENEFIT PLAN OR CARRIER SHALL NOT DISCRIMINATE ,,WITH WITH RESPECT TO PARTICIPATION ,REFERRAL ,,OR OR REIMBURSEMENT OF COVERED SERVICES OR INDEMNIFICATIONINDEMNIFICATIONASTOPHARMACISTSWHOAREACTINGWITHINTHESCOPE ASOFTHEIRLICENSE TOUNDERSTATELAW PHARMACISTS,SOLELYONTHE WHO ARE ACTING WITHIN THE SCOPE OF THEIR LICENSE UNDER STATE LA,SOLELY ON THE BASIS OFOFTHE THE TYPE OF LICENSURE.LICENSURE .

N SELECTING PROVIDERS OF HEALTH CARE-CARE SERVICES FOR MEMBERSHIPMEMBERSHIPINAPROVIDERNETWORK IN,AHEALTHBENEFITPLANORCARRIER A PROVIDER NETWORK ,A HEALTH BENEFIT PLAN OR CARRIER SHALL NOT DISCRIMINATE AGAINST PHARMACISTS WHO PROVIDE SERVICES THAT ARE COVERED BY THE PLAN BY PROHIBITING PHARMACISTS FROM MEMBERSHIP IN A PROVIDER NETWORK .

(b) SBSECTIONSUBSECTION (2)(aOFTHISSECTIONSHALLNOTBECONSTRUED(2)(a)OF THIS SECTION SHALL NOT BE CONSTRUED AS:

-3- 1336 (I) PPROHIBITING ROHIBITING A HEALTH BENEFIT PLAN OR CARRIER FROM INCLUDING PROVIDERS IN A PROVIDER NETWORK ONLY TO THE EXTENT NECESSARY TO MEET THE NEEDS OF THE HEALTH BENEFIT PLAN AND ITS ENROLLEES OR FROM LIMITING REFERRALS OR ESTABLISHING ANY OTHER MEASURE DESIGNED TO MAINTAIN QUALITY AND CONTROL COSTS CONSISTENT WITH THE PROVISIONS OF THE HEALTH BENEFIT PLA;PLAN ;

(II) EQUIRINGAHEALTHBENEFITPLANORCARRIERTOCONTRACTREQUIRING WITHA ANY PROVIDER WILLING TO ABIDE BY THE TERMS AND CONDITIONS FOR PARTICIPATION ESTABLISHED BY THE HEALTH BENEFIT PLAN OR CARRIER TO CONTRACT WITHANYPROVIDERWILLINGTOABIDEBYTHETERMSANDCONDITIONSFOR PARTICIPATIONESTABLISHEDBYTHEHEALTHBENEFITPLANORCARRIER ;OR (III) RREQUIRING EQUIRING COVERAGE FOR ANY SERVICE THAT IS NOT OTHERWISE COVERED UNDER THE TERMS OF A HEALTH BENEFIT PLAN .

SECTION2.PAGE 2-HOUSE BILL 26-1336 SECTION 2.

In Colorado RevisedStatutes,12-280-103,amendRevised Statutes, 12-280-103, amend (38.5)(a)(X), (38.5)(a)(XI), (39)(g)(IV) introductory portion, (39)(g)(IV)(C), and (39)(g)(V);

and add (17.5), (38.5)(a)(XII), and (39)(g)(VI)(39)(g)(VII) as follows:

(17.5) "FINAL"FNALPRODUCTVERIFICATION PRODUCT"MEANS VERIFICATION",AFTERPRESCRIPTION MEANS , AFTER PRESCRIPTION OR ORDER INFORMATION IS ENTERED INTO A PHARMACY S'S ELECTRONIC SYSTEM AND REVIEWED BY A PHARMACIST FOR ACCURACY ,THERAPEUTIC APPROPRIATENESS , THERAPEUTICAPPROPRIATENESSAND ,ANDOTHERASPECTSOFDRUGREGIMENOTHER REVIEWASPECTS ,APHYSICALVERIFICATIONTHATTHEDRUGOF DEVICEDRUG ,ORPRODUCTREGIMEN SELECTEDREVIEW FROM,A PHYSICAL VERIFICATION THAT THE PHARMACYDRUG S,DEVICE INVENTORY,OR ISPRODUCT THESELECTED CORRECTFROMTHEPHARMACY DRUG'SINVENTORYISTHECORRECTDRUG ,DRUGSTRENGTH , DRUG STRENGTH ,DRUG FORMULATION ,DEVICE, DEVICE ,OR PRODUCT FOR THE PRESCRIPTION OR ORDER.ORDER .

-4-(38.5) 1336(a) (38.5)(a) "Practice as apharmacytechnician"meansengagingina anyofthefollowingactivitiesinvolvedinthepracticeofpharmacy,underpharmacy technician" means engaging in any of the following activities involved in the practice of pharmacy, under the supervision and delegation of a supervising pharmacist:

(X) RedispensingRedispensingaprescriptiondrugpursuanttosection12-280-141 a prescription drug pursuant to section 12-280-141 (9)(b) and (9)(c);

and (XI) Requesting refill authorization from the prescriber or prescriber'sagentandprescriber'sagentandreceivingclarifyingprescriptioninformationfromthe receivingprescriber clarifyingor prescriptionprescriber's informationfromagent;D the(XII) prescriberF orINAL prescriber'sPRODUCT agent;VERIFICATION FOR A DRUG ,DEVICE , OR PRODUCT THAT IS NOT A CONTROLLED SUBSTANCE .

(XII) F INAL PRODUCT VERIFICATION FOR A DRUG ,DEVICE ,OR PRODUCT THAT IS NOT A CONTROLLED SUBSTANCE .

(IV) Fordrugsthatarenotcontrolledsubstances,drugcategories,For drugs that are not controlled substances, drug categories, or devices that are prescribed in accordance with the product's FDA-approvedFDA-approvedlabelingandtopatientswhoareat labelingleast andtwelveyearsof toage patientsPAGE who3-HOUSE areBILL at26-1336 least twelve years of age OLD and that are limited to conditions that:

(C) Have a test that is used to guide diagnosis or clinical decision-making and is waived under the federal "Clinical Laboratory ImprovementImprovementAmendmentsof1988",Pub.L.100-578,asamended,or AmendmentsAND of, 1988",IF Pub.L.TESTING OR TREATMENT OCCURS,FOR A PATIENT TWELVE YEARS OLD OR OLDER BUT UNDER EIGHTEEN YEARS OLD ,THE PATIENT S PRIMARY CARE PROVIDER IS NOTIFIED AS SOON AS PRACTICABLE CONSISTENT WITH THE FEDERAL "HEALTH INSURANCE P ORTABILITYAND A CCOUNTABILITYA CTOF 1996",PUB .L.104-191,OR,IF THE PATIENT DOES NOT HAVE OR DISCLOSE A PRIMARYCAREPROVIDER THEPATIENT 'SPHARMACISTREFERSTHEPATIENT TO A PRIMARY CARE PROVIDER FOR FURTHER CARE;