HB 26-1336

HB 26-1336, titled "Increase Access to Pharmacy Services," aims to expand health insurance coverage for services provided by pharmacists in Colorado. This includes allowing health benefit plans and Medicaid to cover more services that fall within a pharmacist’s scope of practice, such as certain medical consultations and treatments. The bill also prevents discrimination against pharmacists based on their license type when it comes to reimbursement and network inclusion. Additionally, the legislation updates regulations for pharmacy practices, including how pharmacies verify medication orders filled by technicians or automated systems, ensuring accuracy and quality control. Since the bill has been signed into law, these changes are now in effect, enhancing patient access to pharmacist-provided care while maintaining safety standards.

Official Summary

Under current law, a pharmacist may receive reimbursement under a health benefit plan and under the medical assistance program (medicaid) for health-care services provided pursuant to a collaborative pharmacy practice agreement. If certain conditions are met, the bill requires health benefit plans that provide hospital, surgical, or medical expense insurance to provide coverage for health-care services provided by a pharmacist that 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. The bill does not require a health benefit plan or health insurance carrier to contract with any provider willing to abide by the terms and conditions for participation established by the health benefit plan or health insurance carrier.     The bill makes changes to the definitions in the pharmacy practice 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 technician or other automated technology. For drug, device, or product orders that are not for controlled substances, final product verification may be delegated by a supervising pharmacist to a certified pharmacy technician or pharmacy intern. The process requires a pharmacy or 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 state board of pharmacy is required to adopt rules relating to final product verification no later than December 31, 2026.     Under current law, a pharmacist has independent prescriptive authority for 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 authority for drugs that are not controlled substances, drug categories, or devices that are prescribed to patients who are 5 years old or older but younger than under 12 years old for conditions that do not require a new diagnosis, 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. Further, if a pharmacist tests or treats any patient under 18 years old, the bill requires a pharmacist to notify the patient's primary care provider consistent with health-care privacy laws, or, if the patient does not have or disclose a primary care provider, refer the patient to a primary care provider for further care.(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)

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