Bill > H5627

This bill requires health insurance providers (including group health insurance contracts, hospital and medical expense insurance policies, and health maintenance organizations) to provide coverage for pharmacists' services starting January 1, 2026. The bill defines these services as including patient evaluation and management (which involves taking medical history, conducting examinations, and making medical decisions), medication therapy management review, immunization education and administration, medication administration, and ordering and evaluating clinical laboratory tests. Importantly, insurance carriers cannot require supervision, signature, or referral from other healthcare providers as a condition of reimbursing pharmacists, though they are not required to pay for duplicate services. The bill mandates that health plans include an adequate number of pharmacists in their provider networks, specifying that simply including pharmacies in drug benefit networks does not satisfy this requirement. The coverage applies primarily to services within the insurer's network, but insurers must also provide coverage outside the network if the required services are unavailable within their network. The bill will automatically expire on January 1, 2030, unless the general assembly extends it, and applies to medical assistance programs, nonprofit hospital and medical service corporations, and health maintenance organizations.

Health and Social Services

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