BILL ANALYSIS Ó
AB 1114
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CONCURRENCE IN SENATE AMENDMENTS
AB
1114 (Eggman)
As Amended August 24, 2016
2/3 vote. Urgency
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|ASSEMBLY: |79-0 |(June 1, 2015) |SENATE: |38-1 |(August 25, |
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|COMMITTEE VOTE: |16-0 |(August 30, |RECOMMENDATION: |concur |
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(Health)
Original Committee Reference: HEALTH
SUMMARY: Requires specified pharmacy services to be covered
under Medi-Cal, and specifies the rate of reimbursement for
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these services at 85% of the fee schedule for physician services
under Medi-Cal. Contains an urgency clause to ensure that the
provisions of this bill go into immediate effect after
enactment. Specifically, this bill:
1)Specifies the following pharmacy services as a benefit under
the Medi-Cal program, subject to approval by the federal
Centers for Medicare and Medicaid Services:
a) Furnishing travel medications;
b) Furnishing naloxone hydrochloride;
c) Furnishing self-administered hormonal contraception;
d) Initiating and administering immunizations; and,
e) Providing tobacco cessation counseling and furnishing
nicotine replacement therapy.
2)Requires the Department of Health Care Services (DHCS) to do
the following: a) establish a fee schedule for the list of
pharmacist services; and, b) specify the rate of reimbursement
to be at 85% of the fee schedule for physician services under
Medi-Cal.
3)Requires a pharmacist to be enrolled as an ordering,
referring, and prescribing provider under the Medi-Cal program
prior to rendering a pharmacist service that is submitted by a
Medi-Cal pharmacy provider for reimbursement under this bill.
4)Requires the Director of DHCS to seek any necessary federal
approvals for purposes of this bill, prohibits implementation
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until such approvals are obtained, and implemented only if
federal financial participation is available.
5)Specifies that this bill does not restrict nor prohibit any
services currently provided by pharmacists as authorized by
law, as specified.
6)Authorizes DHCS to implement, interpret, or make specific this
bill, without taking any regulatory action, as specified.
Requires DHCS to adopt regulations by July 1, 2021 and provide
a status report to the Legislature, as specified.
The Senate amendments require specified pharmacist services to
be covered under Medi-Cal.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)One-time costs of $400,000 to $600,000 to make changes to the
system for processing Medi-Cal payments to allow pharmacist
services to be reimbursed at the rate level specified in this
bill (25% General Fund and 75% federal funds).
2)Unknown cost savings due to a shift from services being
provided by physicians to those services being provided by
pharmacists (General Fund and federal funds). Under this
bill, Medi-Cal beneficiaries would be able to access certain
services from a pharmacist without the need to see a physician
to get a prescription. This bill requires pharmacists to be
reimbursed at 85% of the rate paid to physicians. The extent
of the cost savings from shifting from physician services to
pharmacist services is unknown.
3)Likely overall cost savings to the Medi-Cal program due to
increased utilization of certain drugs prescribed and
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dispensed by pharmacists (General Fund and federal funds).
Under this bill, it is likely that there will be increased
utilization of certain drugs, because it will be easier for
some Medi-Cal beneficiaries to access those drugs directly
from a pharmacist without the need for a physician visit.
Under current law, the drugs that can be provided by a
pharmacist in this manner include smoking cessation drugs,
contraceptives, naloxone (a drug that prevents opioid
overdoses), and immunizations. These types of drugs have been
shown to result in overall health care cost savings, so it is
likely that any overall increase in their utilization by
Medi-Cal beneficiaries is likely to reduce long-term Medi-Cal
spending.
COMMENTS: According to the author, regulations were recently
finalized (2016) to allow California pharmacists to provide
hormonal contraceptives, the opioid overdose drug naloxone, and
nicotine replacing products for smoking cessation directly to
patients. This bill will improve access to these vital health
services by authorizing the DHCS to establish a system for
pharmacists to provide services in the Medi-Cal program. This
bill was not introduced earlier this year because the last
regulations to implement new pharmacist authorities were not
finalized until after the bill introduction deadline.
Discussions have since progressed with DHCS on the best
structure for this bill. The author concluded this bill is
necessary to pass this bill this year so that Medi-Cal patients
can gain access to these health care services right away.
The Pharmacy Act authorizes pharmacists to furnish compounded
drug products, transmit a valid prescription to another
pharmacist, and administer drugs and biologicals pursuant to a
prescriber's order. SB 493 (Hernandez), Chapter 469, Statutes
of 2013, expanded the scope of pharmacists to authorize them to
furnish self-administered hormonal contraceptives, vaccines,
nicotine replacement products, and travel medications.
Additionally, SB 493 authorized the Board of Pharmacy (BOP) to
recognize Advance Practice Pharmacists who can perform patient
assessments, order and interpret drug therapy-related tests,
refer patients to other health care providers, participate in
the evaluation and management of diseases and health conditions
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in collaboration with other health care providers, and initiate,
adjust, or discontinue drug therapy. AB 1535 (Bloom), Chapter
326, Statutes of 2014, additionally authorized pharmacists to
furnish naloxone hydrochloride. Regulations were adopted by the
BOP on the furnishing of naloxone and nicotine replacement
products on January 2016 and the furnishing of self-administered
hormonal contraceptives were adopted in April 2016. The
regulations for the furnishing of travel medications, and
administration of vaccinations are currently pending.
Analysis Prepared by:
Rosielyn Pulmano / HEALTH / (916) 319-2097 FN:
0005002