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Medicaid Reimbursement For Services By Pharmacists

Concerning reimbursement for pharmacists' services under the medical assistance act, and, in connection therewith, making an appropriation.
2021 Regular Session
Health Care & Health Insurance
Professions & Occupations
Bill Summary

Under the act, a pharmacist is eligible for reimbursement under the medical assistance program for certain medically necessary pharmacist services, as described in the act, that are not duplicative of other pharmacist services or programs reimbursed under the medical assistance program. The department of health care policy and financing shall include services reimbursed pursuant to the act in the review of provider rates for the medical assistance program.

Further, the act allows a pharmacist or pharmacy that dispenses or administers extended-release injectable medications for the treatment of mental health or substance use disorders to seek reimbursement for those medications under the medical assistance program as either a pharmacy benefit or as a medical benefit.

The act requires that costs associated with services provided by clinical pharmacists through a federally qualified health center (FQHC) be considered allowable costs for the purpose of the FQHC's cost report and be included in the calculation of the reimbursement rate for a patient visit at an FQHC.

The act appropriates $372,554 to the department of health care policy and financing from the general fund and the healthcare affordability and sustainability fee cash fund to implement the act.

(Note: This summary applies to this bill as enacted.)


Became Law


Bill Text

The effective date for bills enacted without a safety clause is August 7, 2024, if the General Assembly adjourns sine die on May 8, 2024, unless otherwise specified. Details