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Workable Compromise Seems Uncertain for Pharmacist Care Coverage

2019-02-08T12:27:47+00:00February 8th, 2019|

Senate Bill 108 – Coverage for Pharmacist Care
Authored by Sen. Ron Grooms (R-Jeffersonville)                                                                                               

Requires an accident and sickness insurer that enters into a preferred provider agreement to: (1) reimburse for health care service provided by a pharmacist within the scope of practice to the same extent and in the same manner as the insurer would reimburse certain other health care providers; and (2) demonstrate an adequate number of pharmacists within a reasonable proximity to insureds. Requires a preferred provider agreement to provide for the reimbursement.

Chamber Position: Oppose

The Latest: Heard in the Senate Insurance and Financial Institutions Committee, where chairman Eric Bassler (R-Washington) held the bill and asked that the parties work together to come to a solution. Given the divide, the Chamber is uncertain as to whether or not that will be possible.

Chamber Action/Commentary:  The bill, as written, is a mandate on health insurance plans. It essentially requires a reimbursement rate to be paid to a pharmacist (within their scope of practice) to the same extent that a physician would be paid or another provider. In all fairness to Sen. Grooms and the pharmacists, they discussed an amendment to the bill which would have removed the mandated reimbursement and would have required insurers to allow them to participate in the network (which they can do now if they have a large enough group). The amendment was also to make it clear that the state plan was not included in the bill. However, the amendment was not filed in a timely fashion so only a few people had a copy of what it was that was actually being discussed. The Indiana Pharmacists Alliance supported the bill along with several individual pharmacists who testified.

The Indiana Chamber, the Indiana Manufacturers Association, America’s Health Insurance Plans, Anthem and CareSource all testified against the bill. At the center of the opposition: This gets into the contracts between providers (pharmacists specifically) and insurance carriers. This is a mandate on fully insured plans and this bill only covers about 20% of the marketplace. Self-insured plans would not be included in this legislation because they fall under ERISA (the Employee Retirement Income Security Act of 1974).

There is also a significant price tag attached to the bill and that impact would have a similar impact on small businesses.  If this is such an important issue, why would the state plan be exempted?  The Chamber explained that while larger employers in some cases may be able to negotiate with providers, small group fully insureds do not and rely on the carriers to negotiate discounts on price.

Resource: Mike Ripley at (317) 264-6883 or email: mripley@indianachamber.com