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  • NJ A1443
  • Requires coverage of medication therapy management in Medicaid and NJ FamilyCare.
Introduced
(1/27/2016)
In Committee
(1/30/2017)
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill requires the coverage of medication therapy management services in Medicaid and NJ FamilyCare. The bill defines medication therapy management as the systematic process performed by a pharmacist or physician designed to optimize therapeutic outcomes through improved medication use and reduced risk of adverse drug events, including: · a medication therapy review and in-person consultation relating to all medications, vitamins, and herbal supplements currently being taken by an individual; · a medication action plan communicated to the individual or the individual's caretaker and the individual's primary health care provider or other appropriate prescriber of medication to address safety issues, inconsistencies, duplicative therapy, omissions, and medication costs; and · documentation and follow-up with the individual or the individual's caretaker to ensure consistent levels of pharmacy services and positive outcomes, including (as deemed necessary to maintain or improve positive outcomes) follow-up discussions with the individual's primary health care provider or other appropriate prescriber. The bill requires that Medicaid and NJ FamilyCare cover medication therapy management services for enrollees (1) who take at least three different prescription drugs for at least two chronic medical conditions, (2) whose primary health care provider or other appropriate prescriber identifies the individual as having a prescription drug therapy problem and refers the individual to a pharmacist for medication therapy management, or (3) who meets other criteria established by the Commissioner of Human Services. The bill requires that a Medicaid managed care organization contract with a third party entity to administer a medication therapy management program, and requires that the Division of Medical Assistance and Health Services contract with a third party entity to administer the program for fee-for-service recipients. The bill provides that the contract must include the following requirements: · The third party entity must guarantee demonstrated annual savings, including savings associated with cost avoidance at least equal to the amount owed to the third party entity under the contract, with any shortfall amount refunded to the State. · The third party entity, and the managed care organization, as applicable, must report annually to the division on the costs, savings, cost avoidance, return on investment, and change in patient outcomes related to the provision of medication therapy management services. · The third party entity must contract with pharmacies or pharmacists to provide medication therapy management services. Medication therapy management services required by the Medicaid managed care contract must not be provided by employees of the managed care organization or the third party entity. The bill requires that fees paid for medication therapy management services are reasonable and based on the resources and time required to provide the service. The bill requires that fees for pharmacist-delivered medication therapy management services be separate from reimbursements for prescription drug products or dispensing services. The bill specifies that if any part of a medication action plan developed by a pharmacist incorporates services outside a pharmacist's scope of practice, the express authorization of the individual's primary health care provider or other appropriate prescriber must be obtained prior to making any changes to the individual's medication treatment regimen. The bill requires the Commissioner of Human Services to adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of the bill. The bill excludes residents of nursing facilities, assisted living facilities, or adult day health facilities licensed pursuant to the "Health Care Facilities Planning Act," P.L.1971, c.136 (C.26:2H-1 et seq.), from the bill's medication therapy management coverage requirements. The bill takes effect on the first day of the seventh month following the date of enactment, and applies to any Medicaid managed care contract executed on or after the effective date. The bill requires the Commissioner of Human Services to take anticipatory administrative actions necessary to implement the bill's requirements.
2nd Reading in the Assembly, Health and Senior Services
Reported out of Assembly Comm. with Amendments, 2nd Reading  (on 1/30/2017)
 
 
Date Chamber Action Description
1/30/2017 Assembly Appropriations Hearing (19:00 1/30/2017 A-4352 pending referral)
1/30/2017 A Reported out of Assembly Comm. with Amendments, 2nd Reading
1/30/2017 Assembly Appropriations Hearing (13:00 1/30/2017 Committee Room 11, 4th Floor)
6/2/2016 A Reported out of Asm. Comm. with Amendments, and Referred to Assembly Appropriations Committee
6/2/2016 Assembly Health and Senior Services Hearing (10:00 6/2/2016 Committee Room 11, 4th Floor)
1/27/2016 A Introduced, Referred to Assembly Health and Senior Services Committee
Date Motion Yea Nay Other
Detail 1/30/2017 Assembly Appropriations Committee: Reported with Amendments 11 0 0
Detail 6/2/2016 Assembly Health and Senior Services Committee: Reported with Amendments 12 0 1