Senate Bill No. 580

(By Senators Yost and Klempa)

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[Introduced February 21, 2011; referred to the Committee on Health and Human Resources; and then to the Committee on the Judiciary.]

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A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new article, designated §16-43-1, §16-43-2, §16-43-3, §16-43-4, §16-43-5 and §16-43-6, all relating to creating the Medication Therapy Management Act; and specifying that fees for third-party providers pay for the therapy under this act.

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 article, designated §16-43-1, §16-43-2, §16-43-3, §16-43-4, §16-43-5 and §16-43-6, all to read as follows:

ARTICLE 43. MEDICATION THERAPY MANAGEMENT ACT.

§16-43-1. Medication therapy management program.

    A medication therapy management program defined in this article is a program of drug therapy management furnished by a duly licensed pharmacist under the West Virginia Code, and that is designed to assure, with respect to targeted patients that medications are appropriately used to optimize therapeutic outcomes through improved medication use, and to reduce the risk of adverse events, including adverse drug interactions. Such a program may distinguish between services in ambulatory and institutional settings. Upon implementation, third-party providers and state health care providers shall pay a fee to pharmacy providers for medication therapy management services. Targeted patients are individuals who have at least one chronic disease, including, but not limited to, diabetes, asthma, chronic obstructive pulmonary disease or other chronic lung disorders, hypertension, hyperlipidemia, congestive heart failure, chronic pain disorder or behavioral health disorder, and are taking multiple drugs to treat one or more such conditions. A patient with a prescription drug therapy problem who is identified by the primary health care provider and is eligible for medication therapy management services under the plan, self-pay.

§16-43-2. Definition.

    For purpose of this article:

    "Medication therapy management" means the one-on-one provision of the following pharmaceutical care services by a licensed pharmacist to optimize the therapeutic outcomes of the patient's medications. Working with the patient to develop a personal medication record as part of a personal health record that contains all prescribed and nonprescription drugs, herbal products, and dietary supplements taken by the patient.

§16-43-3. Patient treatment.

    "Medication therapy management" may include:

    (a) Interviewing the patient to gather data, including demographic information, general health and activity status, medical history, medication history, immunization history, and to collect the patient's personal assessment about his or her disease or condition and medication use;

    (b) Performing necessary clinical assessments of the patient's health status, including current or previous diseases or conditions;

    (c) Assessing patient values, preferences, quality of life, goals of therapy, cultural issues, education level, language barriers, literacy level and other characteristics affecting the patient's communication skills that could affect patient outcomes;

    (d) Monitoring and evaluating the patient's responses to his or her medication therapies, including the safety and effectiveness of those therapies;

    (e) Assessing, identifying, prioritizing and developing a plan for resolving medication-related problems related to the clinical appropriateness of each medication, the appropriateness of the dosage of each medication, including considerations of indications, contra-indications, and potential adverse effects, adherence to regimen, untreated diseases or conditions, medication costs, and provider access considerations;

    (f) Providing consultative services for the patient, intervening to address medication-related issues, and, when the pharmacist believes it will be beneficial to the patient's health, referring the patient to his/her regular health care provider for evaluation and additional referral(s);

    (g) Communicating information to the primary health care provider or other health care professionals, including consultation on the selection of medications, suggestions to address identified medication problems, updates on the patient's progress, and recommended follow-up care;

    (h) Providing education and training on the appropriate use of medications and monitoring devices;

    (i) Coaching patients to manage their own medications and promote their wellness;

    (j) Evaluating the patient's ability to detect symptoms that could be attributed to adverse reactions or interactions from medications;

    (k) Monitoring, and assessing the results of a patient's laboratory testing, including those performed in the pharmacy setting;

    (l) Increasing patient adherence to prescription medication regimens through medication refill reminders, compliance aids (such as pill boxes, timers, packaging, and calendaring, and other appropriate and cost-effective interventions);

    (m) Detection of adverse drug events, as well as overuse and underuse of prescription and nonprescription products;

    (n) Coordinating and integrating medication therapy management services within the broader health care management services being provided to the patient as recommended by the primary healthcare provider and/or other healthcare professional or specialist;

    (o) Performing follow-up MTM services for the maintenance and support of the patient, as recommended by the primary health care provider and/or other health care professional or specialist; and

    (p) Maintaining all necessary documentation, including the following and any other records required for compliance with state and federal laws and regulations pertaining to maintenance of patient records:

    (1) Patient demographics and basic identifying information;

    (2) Subjective, meaning, patient-reported, information;

    (3) Objective, meaning, service provider-based, observations regarding known allergies, diseases, conditions, laboratory test results, vital signs, physical exam results, review of systems, and recorded medical diagnoses;

    (4) Assessment of medication-related problems;

    (5) Written care plan;

    (6) Recorded collaborative communication with primary health care providers and other healthcare professionals;

    (7) Patient-specific lists of actions to be followed in tracking progress in medication self-management;

    (8) Any relevant transition plan or scheduling of follow-up visits and billing information, including level of patient care, level of complexity and charges;

    (9) Patient health and medication literacy assessment; and

    (10) Patient's pharmacy encounter satisfaction survey.

    (q) Providing the individual with a written or printed summary of the results of such medication therapy management review session.

§16-43-4. Reimbursement eligibility.

    To be eligible for reimbursement for services provided under this section, a pharmacist shall:

    (a) Hold a valid and current license issued by the West Virginia Board of Pharmacy;

    (b) Have completed a structured and comprehensive education program approved by the West Virginia Board of Pharmacy or the American Council of Pharmaceutical Education for the provision and documentation of pharmaceutical care management services that has both clinical and didactic elements;

    (c) Develop a structured written patient care process protocol; and

    (d) Maintain an electronic patient record system for outcomes analysis and patient care.

§16-43-5. Evaluation.

    The Board of Pharmacy shall evaluate the effect of medication therapy management on quality of care, patient outcomes, and program costs, and shall include a description of any savings generated in the medical assistance and general assistance medical care programs that can be attributable to this coverage. The evaluation shall be submitted to the Legislature within two years of the effective date of the legislation.

§16-43-6. Payment of fees.

    (a) Upon implementation of this legislation, third-party providers shall pay a fee to pharmacy providers for medication therapy management services. These services may also be provided by pharmacists on a self-pay basis when a patient does not have a third-party provider.

    (b)The fee shall be calculated using one or more quarter-hourly rates implemented by formal regulation that are designed to reimburse the pharmacist or pharmacy based on time spent in providing the medication therapy management services.

    (c) Third-Party Plans shall pay the fee, separate from reimbursement for prescription drug product or dispensing services, to any individual pharmacist or pharmacy participating in the plans that provides medication therapy management services.

    NOTE: The purpose of this bill is to create a medication management therapy program and setting out the funding source for paying for the program.

    The article is new; therefore, strike-throughs and underscoring have been omitted.