Senate Bill No. 2

(By Senators Foster and Klempa)

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[Introduced January 11, 2012; referred to the Committee on Health and Human Resources; and then to the Committee on Finance.]

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A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §9-2-9a, relating to creating a medication therapy management services program for Medicaid recipients; authorizing licensed pharmacists to consult with Medicaid patients to ensure they are taking the appropriate drugs and the drugs are not interfering with each other; setting forth the specific services to be provided by a pharmacist; setting forth eligibility requirements for participating pharmacists; and providing for a pilot program for certain Medicaid patients.

Be it enacted by the Legislature of West Virginia:

    That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §9-2-9a, to read as follows:

ARTICLE 2. COMMISSIONER OF HUMAN SERVICES; POWERS, DUTIES AND RESPONSIBILITIES GENERALLY.

§9-2-9a. Medication therapy management services program.

    (a) The Secretary of the Department of Health and Human Resources shall develop a medication therapy management services program for Medicaid recipients taking four or more prescriptions to treat or prevent two or more chronic medical conditions, or a Medicaid recipient with a drug therapy problem that has been identified or is likely to result in significant nondrug program costs. For purposes of this section, "medication therapy management" means the provision of the following pharmaceutical care services by a licensed pharmacist to optimize the therapeutic outcomes of the patient's medications:

     (1) Performing or obtaining necessary assessments of the patient's health status;

    (2) Formulating a medication treatment plan;

     (3) Monitoring and evaluating the patient's response to therapy, including safety and effectiveness;

    (4) Performing a comprehensive medication review to identify, resolve and prevent medication-related problems, including adverse drug events;

    (5) Documenting the care delivered and communicating essential information to the patient's other primary care providers;

    (6) Providing verbal education and training designed to enhance patient understanding and appropriate use of the patient's medications;

    (7) Providing information, support services and resources designed to enhance patient adherence with the patient's therapeutic regimens; and

    (8) Coordinating and integrating medication therapy management services within the broader health care management services being provided to the patient.

    Nothing in this section expands or modifies the scope of practice of the pharmacist as set forth in article five, chapter thirty of this code.

    (b) To be eligible for reimbursement for services under this section, a pharmacist must meet the following requirements:

    (1) Have a valid license issued under article five, chapter thirty of this code;

    (2) Have graduated from an accredited college of pharmacy on or after May 1996 or completed a structured and comprehensive education program approved by the Board of Pharmacy and the American Council of Pharmaceutical Education for the provision and documentation of pharmaceutical care management services that has both clinical and didactic elements;

    (3) Be practicing in an ambulatory care setting as part of a multidisciplinary team or have developed a structured patient care process that is offered in a private or semiprivate patient care area that is separate from the commercial business that also occurs in the setting, or in home settings, excluding long-term care and group homes, if the service is ordered by the provider-directed care coordination team; and

    (4) Make use of an electronic patient record system that has been approved by the Secretary or the Board of Pharmacy.

    (c) For purposes of reimbursement for medication therapy management services, the secretary may enroll individual pharmacists as medical assistance and general assistance medical care providers. The secretary may also establish contact requirements between the pharmacist and recipient, including limiting the number of reimbursable consultations per recipient.

    (d) If there are no pharmacists who meet the requirements of subsection (b) of this section practicing within a reasonable geographic distance of the Medicaid patient, a pharmacist may provide the services via two-way interactive video. Reimbursement shall be at the same rates and under the same conditions that would otherwise apply to the services provided. To qualify for reimbursement under this paragraph, the pharmacist providing the services must meet the requirements of subsection (b) of this section, and must be located within an ambulatory care setting approved by the secretary. The patient must also be located within an ambulatory care setting approved by the secretary.

    (e) The secretary shall establish a pilot project for an intensive medication therapy management program for Medicaid patients identified by the secretary with multiple chronic conditions and a high number of medications who are at high risk of preventable hospitalizations, emergency room use, medication complications, and suboptimal treatment outcomes due to medication-related problems. For purposes of the pilot project, medication therapy management services may be provided in a patient's home or community setting, in addition to other authorized settings. The secretary may waive existing payment policies and establish special payment rates for the pilot project. The pilot project must be designed to produce a net savings to the state compared to the estimated costs that would otherwise be incurred for similar patients without the program. The pilot project must begin by January 1, 2013, and end June 30, 2015.

    NOTE: The purpose of this bill is to create a medication therapy management services program for Medicaid recipients. The bill permits licensed pharmacists to consult with Medicaid patients to ensure they are taking the appropriate drugs and the drugs are not interfering with one another. The bill sets forth the specific services to be provided by a pharmacist and eligibility requirements. The bill also provides for a pilot program for certain Medicaid patients.

     This section is new; therefore, strike-throughs and underscoring have been omitted.