HB 165/a PHARMACY PROVIDER REIMBURSEMENT

Rep Gail "Missy" Armstrong

Actions: [2] HHHC/HAFC-HHHC [5] DP-HAFC [12] DP/a [14] PASSED/H (66-0) [9] SHPAC-SHPAC- DP [14] PASSED/S (37-0) SGND BY GOV (Mar. 1) Ch. 35.

Scheduled: Not Scheduled

 HB 165 requires the Health Authority Department to  provide reimbursment to communtiy pharmacies for services to Medicaid beneficiaries. an appropriation of $7,500,000 is made available to reimbursement , while a study to determing reasonable reimbursment is made. Certain pharmacies are not elegible for this reimbursement such as government owned pharmaices.  

 Synopsis: HB165 relates to reimbursement to pharmacies that serve Medicaid recipients. A study by the Health Authority Department to establish reimbursement to these providers is also required.
Analysis: HB 165 modifies  the Public Assistance Act in which community based pharmacies would now be reimbursed for their services to Medicaid beneficiaries. HB 165 also contains an appropriation for implementation of the reimbursement program. The appropriation is for seven million, five hundred thousand dollars ($7,500,000) to increase reimbursement and to conduct the study for reasonable professional fees for community pharmacies. 
The Department will issue a request for proposals from the managed care organizations to submit proposals for reasonable professional fees. Another consideration is that the proposals consider ingredient cost of a drug at least equal to the national average drug acquisition cost.
By January 1, 2025 and annually t hereafter, the Department is to complete a list of all community based pharmacy providers and publish it on its website. 
Certain pharmacies are not eligible for this reimbursement, to include: a government owned pharmacy, hospital owned pharmacy, owned by corporation that owns hospitals, an extension of a medical practice or special facility, or a corporate chain of pharmacies with stores out the state or mail order pharmacies. 


 

 Amended February 9, 2024 in HAFC

HAFCa/HB 165: The House Appropriation and Finance Committee amendment to HB165a strikes the requirement that the Health Authority conduct a study to determine fees for pharmacies that provide services to Medicaid recipients. Also a reference to an appropriation has been struck. 
Also struck on page 2,  is the requirement that the Department issue a request for proposal from a managed care organization and that the Department conduct a study to determine reasonable fees for professional dispensing fees.
A change in wording from “equal to “ to “no less than” can be found on lines 18 and 19 on page 2, to now read: 
“the professional dispensing fee reimbursed to community-based pharmacy providers shall be “no less than “the professional dispensing fee reimbursed to community based pharmacy providers for covered outpatient drugs in the Medicaid fee-for-service program. “
Lines 13 through 20  on page 4,are to be struck which removes the appropriation of seven million five hundred thousand dollars ($7,500,000) that was to go to the Health Authority.