West Virginia Bill to Expand Pharmacy Prescribing, Reimbursement

West Virginia legislature passes a bill that will affect reimbursement for services that fall within a pharmacist’s purview and are ordinarily provided by other health care providers.

The West Virginian Senate and House of Delegates have passed a bill that will affect reimbursement for services that fall within a pharmacist’s purview and that are ordinarily provided by other health care providers.1,2

Senate Bill 787 provides benefits to pharmacists for care rendered within their scope of practice if such benefits would ordinarily be paid if the service was performed by another health care provider.1

The provider status section is a new addition to Chapter 33-53-1 and states that benefits may not be denied for any health care service performed by a pharmacist licensed within West Virginia, if:2,3

  • The service performed was within the lawful scope of the pharmacist’s license.
  • The plan would have provided benefits if the service had been performed by another health care provider.
  • The pharmacist is included in the plan’s network of participating providers.

Furthermore, in order for their services to be reimbursed under the West Virginia bill, the pharmacist must be included in the plan’s network of participating providers or be employed or contracted by a credentialed facility.2-3

The American Pharmacists Association, American Society of Health-System Pharmacists, National Association of Chain Drug Stores, National Alliance of State Pharmacy Association, and the National Community Pharmacists Association signed a joint letter to Majority Leader Tom Takubo (R-17) and Minority Leader Roman Prezioso (D-13) in support of the bill.4

“While pharmacists are best known for dispensing prescription medications and helping patients use them safely, today’s pharmacists receive clinically-based doctor of pharmacy degrees and have the background and training necessary to provide needed services to patients. Pharmacists are also often the most accessible healthcare professionals for patients,” the groups wrote in the letter.4

The letter also stated that in West Virginia, pharmacists are currently able to prescribe tobacco cessation therapy and self-administered hormonal contraceptives but are not reimbursed like other providers. Bill 787 requires health plans to reimburse pharmacists for these services as they would other health care providers.4

If signed by Gov. Jim Justice, the bill would apply to plans issued or renewed on or after January 1, 2021. Should the governor not take any action, the bill will automatically become law.1

Reference

  • Congratulations to the states making strides toward provider status. APHA website. Published March 10, 2020. https://www.pharmacist.com/CEOBlog/congratulations-states-making-strides-toward-provider-status. Accessed March 17, 2020.
  • Legislation attains provider status for pharmacists. West Virginia Pharmacists Association website. Published February 14, 2020. http://wvpharmacy.org/2020/02/legislation-attains-provider-status-for-pharmacists/. Accessed March 17, 2020.
  • Senate Bill 787. West Virginia Legislature website. http://www.wvlegislature.gov/Bill_Status/bills_history.cfm?year=2020&sessiontype=RS&input=787. Accessed March 17, 2020.
  • APhA Letter of Support. Published February 24, 2020. https://www.pharmacist.com/sites/default/files/Joint_Letter_of_Support_WV.pdf. Accessed March 17, 2020.