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Legislative Update 1.25.21

Legislation to Reimburse Pharmacists Gains Supports
 
House Bill 48, sponsored by Rep. Danny Bentley (R-Russell), has gained support as 41 co-sponsors have signed onto the legislation. The bill as introduced would reimburse pharmacists for the medical services currently within their scope of practice in commercial health insurance plans and workers compensation. It would require these health insurers to set up a clean claims process for pharmacists to be credentialed to bill health insurers. The reimbursements could be no less than the non-physician reimbursement rates. Pharmacists are being asked to provide more patient care during the COVID-19 pandemic, without being reimbursed for services. As Kentuckians need more access to services during the pandemic, now is the time to reimburse pharmacists for these medical services.
 
Read the Full Text of HB 48

Legislative Update | January 25, 2021 

Pharmacy Week in Review:
 
Legislation to Reimburse Pharmacists Gains Supports
 
House Bill 48, sponsored by Rep. Danny Bentley (R-Russell), has gained support as 41 co-sponsors have signed onto the legislation. The bill as introduced would reimburse pharmacists for the medical services currently within their scope of practice in commercial health insurance plans and workers compensation. It would require these health insurers to set up a clean claims process for pharmacists to be credentialed to bill health insurers. The reimbursements could be no less than the non-physician reimbursement rates. Pharmacists are being asked to provide more patient care during the COVID-19 pandemic, without being reimbursed for services. As Kentuckians need more access to services during the pandemic, now is the time to reimburse pharmacists for these medical services.
 
Read the Full Text of HB 48
 
Senate Bill 8 Introduced to Expended Exemptions to Immunizations
 
Senate Bill 8, introduced by Sen. Mike Wilson (R-Bowling Green), would expand exemptions to mandatory vaccination laws to include conscientiously held beliefs, along with religious and medical exemptions. The Department for Public Health (DPH) would be required to create a uniform form in order to provide documentation of the exemption reason that would have to be made publicly available and published online. Given that the legislation is SB 8, it's low number indicates that it is a priority for the Senate and it appears the measure will be acted upon by the Senate Health & Welfare Committee when the Senate returns February 2.
 
Read the Full Text of SB 8
 
Legislation Would Allow APRNs to Prescribe without Collaborative Agreement
 
Legislation filed in the House and Senate would change the requirement for a collaborative agreement between Advanced Practice Registered Nurses (APRNs) and physicians required for prescribing of controlled substances. Current law requires APRNs to wait one year prior to being eligible to enter a practice agreement with a physician to prescribe controlled substances. In SB 78, sponsored by Senate Majority Caucus Chair Julie Raque Adams (R-Louisville), would eliminate the one-year waiting period for APRNs and would eliminate the requirement for a collaborative practice agreement for controlled substances after four years of practicing under the agreement. In the House, Rep. D.J. Johnson (R-Owensboro) would eliminate requirements for out-of-state APRNs to have a collaborative practice agreement for non-scheduled drugs, after 4 years of practice. It would allow licensed nurses to order and administer prescription drugs (HB 202).
 
Read the Full Text of SB 78
Read the Full Text of HB 202

 
 
Pharmacists would have Legal Liability Protections
 
The House and Senate have both introduced legal liability protections for businesses operating under COVID-19. Senate Bill 5 would not only apply to this emergency, it would also apply to any future state or local declared emergency. If an entity, like a pharmacy was deemed essential, they would be afforded sovereign immunity protections under the legislation. It would also apply to pharmacists. If pharmacists were delivering prescriptions, the extension of immunity would apply to them as well.
 
The House version, HB 10 sponsored by Rep. Steve Sheldon (R-Bowling Green), would only apply during the COVID-19 pandemic and would provide retail businesses, including pharmacies, with rebuttable presumption. The bill came under fire from some business groups arguing the measure did not go far enough and needed changes in order to protect business. The House decided to advance the measure acknowledging that changes need to made to the measure.
 
When the General Assembly returns in February, the hope is the Senate will take up SB5, sponsored by Senate President Robert Stivers (R-Manchester). The bill has been heard in the Senate Economic Development Committee for discussions only. Committee members raised concerns about the potential impact on Kentuckians' access to the courts and the need to ensure that the measure is not too broad. Pharmacists interested in having protections should reach out to their Senate member and ask them to vote yes on SB 5.
 
Read the Full Text of SB 5
Read the Full Text of HB 10

 
Legislators Continue to Push Legislation to Reform Medicaid
 
Sen. Stephen Meredith (R-Leitchfield) has once again filed legislation that would eliminate copays in Medicaid managed plans. This legislation seems a moot point since the Cabinet for Health and Family Services has regulations eliminating copays, but Meredith wants to eliminate the statutory authority for any future administration to restore them (SB 55). Meredith has also filed SB 56 that would limit the number of the Medicaid Managed Care Organizations to three. If the measure passes, it would cut in half the current number of Medicaid Managed Care Organizations operating today. Neither measure has been referred to committee.
 
Rep. Steve Sheldon (R-Bowling Green) has filed HB 177 that would require the Department for Medicaid Services to implement the state single pharmacy benefit manager (PBM) starting Jan. 1, 2021. The bill would also require the implementation of a reimbursement methodology and require retroactive reimbursements for pharmacists based on the adopted methodology.
 
The Department for Medicaid Services has contracted with MedImpact to serve as the state single PBM, and they have implemented the required state single preferred drug list (PDL), but they haven't adopted a reimbursement methodology as the law requires.
 
Read the full Text of SB 55
Read the Full Text of SB 56
Read the Full Text of HB 177

 
Medical marijuana legislation introduced; Passage Unlikely
 
Even though House Speaker David Osborne (R-Prospect) publicly stated that it was time for the passage of medical marijuana recognizing that sick people need to be treated as such and not as criminals, Senate leadership is still skeptical about passing legislation. Rep. Jason Nemes (R-Louisville) has once again introduced HB 136 that would legalize medical marijuana use when recommended by a physician. The patient would be required to have a medical card from the physician recommending the use of medical marijuana. Additionally, they would be required to have a consultation with a pharmacist prior to the dispensing of medical marijuana. The legislation has not been assigned to a committee at this time and given that this is a short session, its not likely that it will be heard, but isn't likely that the issue is going away anytime soon.
 
Read the Full Text of HB 136
 
House and Senate Aim to Prohibit Insurers from Delaying Substance Abuse Treatment
 
House Bill 102 and SB 51 would prohibit insurers, including Medicaid Managed Care Organizations (MCOs). from requiring utilization reviews for the treatment of substance use disorder for prescription Suboxone, Vivitrol, or Methadone. Insurers would be required to submit a report of healthcare providers prescribing these treatments for addiction to the Board of Medical Licensure. House Health and Family Services Chair Kim Moser (R-Taylor Mill) has sponsored similar legislation for the last three legislative sessions. Insurers oppose the measure.
 
Read the Full Text of HB 102
Read the Full Text of SB 51

 
High Insulin Cost Concern for Legislators
 
Legislators in both chambers continue to file legislation that would address the high cost of insulin to patients. Rep. Danny Bentley (R-Russell) has filed HB 95 that would cap the cost of a 30-day supply of insulin to $30. In the Senate, SB 110 was filed that would also cap the cost of a monthly supply of insulin to $30. Additionally, it would create  an emergency insulin program that would require insulin manufacturers to provide a stock of free insulin to pharmacies to dispense insulin to uninsured patients or patients who cannot afford insulin. A patient would submit documentation to the pharmacy that they are eligible for an ‘urgent supply of insulin.' The pharmacy would dispense a 30-day supply of insulin within 72-hours of the patient being prescribed the medication. A pharmacist may submit to the manufacturer of the insulin product a claim for replacement insulin, which has 60 days to replace the medication. Starting July 1, 2021, manufacturers shall establish an insulin patient assistance program. If a patient presents documentation that they are eligible for insulin at no-cost—the pharmacy should request a 90-day supply of insulin from the manufacturer. A co-pay may be collected of no less than $30 for a month supply.
 
Although HB 95 has numerous sponsors, it may not cross the finish line this session. A similar measure did pass the House last session, but it was held up in the Senate when a free insulin program was added to the legislation.
 
Read the Full Text of HB 95
Read the Full Text of SB 110

 
Bill Filed to allow Medical Providers to Object to Providing Healthcare
 
Senate Bill 83, filed by Sen. Stephen Meredith (R-Leitchfield), would allow a pharmacist to object to providing healthcare services to a patient where the provider has a moral or ethical objection to providing the medical service. An employer would be prohibited from discriminating against a healthcare provider refusing to provide healthcare service for any reason. An employer could not ask a pharmacist during the hiring process if they would potentially object to any healthcare service. A pharmacist would also be exempt from any liability claim for refusing to provide the service. The bill has not been referred to a committee as of yet.
 
Read the Full Text of SB 83
 
Senate Bill 9 Awaits Governor Signature
 
Sen. Whitney Westerfield (R-Hopkinsville) once again successfully passed SB 9 that would require all healthcare professionals – including pharmacists – to care for any infant born alive through an abortion. The same legislation passed last year but was vetoed by Gov. Beshear and legislators did not have time to override the veto. This year the General Assembly has amble time to override any vetoes, when they return Feb.2.
 
Read the Full Text of SB 9
 
Regulations Update
 
Board Authorized Protocols Amendment Proposed
 
A proposal to amend the board authorized protocol regulations (201 KAR 2:380) would allow pharmacists to offer colorectal cancer screening of patients. Additionally, the regulation would make some clarifying changes that would include for the treatment of alcohol abuse disorder with Naltrexone. It would also allow pharmacists to screen for HIV as well as provide medications for pre and post prophylaxis treatment for HIV. It would also allow pharmacists to screen for hepatitis c screening. Finally, the regulation would allow pharmacists to treat fungal skin infections. A public hearing on the regulation has been scheduled for Feb. 23, and public written comments are due Feb. 28, 2021.
 
Public Hearing Scheduled for Regulation on Pharmacists Reimbursement in Workers Compensation
 
On Jan. 21, a public hearing will be held on Zoom to accept comments on 803 KAR 25:092 amendments that would modify the reimbursement of pharmacies for prescription dispensed to workers' compensation patients. The dispensing fee for pharmacies would remain $5, but the reimbursement for ingredient cost would change. For a generic drug reimbursement, the methodology would be 60% of the average wholesale price (AWP) for brand-named drugs, it would be 85% of AWP. Of course, pharmacists know they don't receive the full benefit of the methodology described in the reimbursement methodology. The regulation allows an insurer to reimburse a pharmacy less that the regulation's prescribed methodology. In amending the regulation, the department didn't include any amendment that would improve transparency in the workers' compensation pharmacy program. If you would like to participate in the public hearing, please contact dale.hamblin@ky.gov. If you would like to submit written comments, you may do so by Jan. 30 by submitting comments to the email address above.
 
Optometrists Dispensing Regulation Referred
 
Regulation 201 KAR 5:140 allowing optometrists to dispense medications has been referred to the Senate and House Licensing & Occupations Committee. The committees can hear the regulation once they return on Feb. 2, and the committees have 60 days to review the regulation. The regulation would allow optometrists to dispense non-controlled substances directly to patients, without any limits. The optometrist would only need to be on the premise for the dispensing to occur. Pharmacists objected to the regulation during the Administrative Regulatory Review Committee, arguing that the legislature had not granted optometrists the authority to dispense. In turn, optometrists argued that patients were having trouble accessing medications and they have the authority to do this because they have the sole authority to determine the practice of optometry. Pharmacists wishing to comment should submit comments directly to their representatives.
 
 
 

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