Senate File 446 - Introduced SENATE FILE 446 BY COMMITTEE ON STATE GOVERNMENT (SUCCESSOR TO SSB 1125) A BILL FOR An Act relating to medication therapy management, providing an 1 appropriation, and including effective date provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2206SV (1) 84 pf/nh

S.F. 446 Section 1. NEW SECTION . 8A.440 Medication therapy 1 management. 2 1. As used in this section unless the context otherwise 3 requires: 4 a. “Eligible employee” means an employee of the state, with 5 the exception of an employee of the state board of regents or 6 institutions under the state board of regents, for whom group 7 health plans are established pursuant to chapter 509A providing 8 for third-party payment or prepayment for health or medical 9 expenses. 10 b. “Medication therapy management” means a systematic 11 process performed by a licensed pharmacist, designed to 12 optimize therapeutic outcomes through improved medication use 13 and reduced risk of adverse drug events, including all of the 14 following services: 15 (1) A medication therapy review and in-person consultation 16 relating to all medications, vitamins, and herbal supplements 17 currently being taken by an eligible individual. 18 (2) A medication action plan, subject to the limitations 19 specified in this section, communicated to the individual and 20 the individual’s primary care physician or other appropriate 21 prescriber to address safety issues, inconsistencies, 22 duplicative therapy, omissions, and medication costs. The 23 medication action plan may include recommendations to the 24 prescriber for changes in drug therapy. 25 (3) Documentation and follow-up to ensure consistent levels 26 of pharmacy services and positive outcomes. 27 2. a. The department shall amend the contract for the 28 provision of medication therapy management services as 29 initially required pursuant to 2010 Iowa Acts, chapter 1193, 30 section 166, to provide for the continuation of medication 31 therapy management services for eligible employees who meet any 32 of the following criteria: 33 (1) An individual who takes four or more prescription drugs 34 to treat or prevent two or more chronic medical conditions. 35 -1- LSB 2206SV (1) 84 pf/nh 1/ 4

S.F. 446 (2) An individual with a prescription drug therapy problem 1 who is identified by the prescribing physician or other 2 appropriate prescriber, and referred to a pharmacist for 3 medication therapy management services. 4 (3) An individual who meets other criteria established by 5 the third-party payment provider contract, policy, or plan. 6 b. The contract shall require the entity to provide annual 7 reports to the general assembly detailing the costs, savings, 8 estimated cost avoidance and return on investment, and patient 9 outcomes related to the medication therapy management services 10 provided. The entity shall guarantee demonstrated annual 11 savings, including any savings associated with cost avoidance 12 at least equal to the program’s costs with any shortfall amount 13 refunded to the state. The contract shall include terms, 14 conditions, and applicable measurement standards associated 15 with the demonstration of savings. The department shall verify 16 the demonstrated savings reported by the entity was achieved 17 in accordance with the agreed upon measurement standards. The 18 entity shall be prohibited from using the entity’s employees to 19 provide the medication therapy management services and shall 20 instead be required to contract with licensed pharmacies, 21 pharmacists, or physicians. 22 c. The department may establish an advisory committee 23 comprised of an equal number of physicians and pharmacists 24 to provide advice and oversight in evaluating the results of 25 the program. The department shall appoint the members of the 26 advisory committee based upon designees of the Iowa pharmacy 27 association, the Iowa medical society, and the Iowa osteopathic 28 medical association. 29 d. The fees for pharmacist-delivered medication therapy 30 management services shall be separate from the reimbursement 31 for prescription drug product or dispensing services; shall 32 be determined by each third-party payment provider contract, 33 policy, or plan; and must be reasonable based on the resources 34 and time required to provide the service. 35 -2- LSB 2206SV (1) 84 pf/nh 2/ 4

S.F. 446 e. A fee shall be established for physician reimbursement 1 for services delivered for medication therapy management as 2 determined by each third-party payment provider contract, 3 policy, or plan, and must be reasonable based on the resources 4 and time required to provide the service. 5 f. If any part of the medication therapy management 6 plan developed by a pharmacist incorporates services which 7 are outside the pharmacist’s independent scope of practice 8 including the initiation of therapy, modification of dosages, 9 therapeutic interchange, or changes in drug therapy, the 10 express authorization of the individual’s physician or other 11 appropriate prescriber is required. 12 Sec. 2. APPROPRIATION —— DEPARTMENT OF ADMINISTRATIVE 13 SERVICES. There is appropriated from the general fund of the 14 state to the department of administrative services for the 15 fiscal year beginning July 1, 2011, and ending June 30, 2012, 16 the following amount or so much thereof as is necessary, to be 17 used for the purpose specified: 18 For the medication therapy management program as enacted in 19 this Act: 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 481,000 21 Sec. 3. REPEAL. 2010 Iowa Acts, chapter 1193, section 166, 22 is repealed. 23 Sec. 4. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 24 immediate importance, takes effect upon enactment. 25 EXPLANATION 26 This bill relates to medication therapy management. The 27 bill codifies the pilot program for medication therapy 28 management implemented on July 1, 2010, for eligible state 29 employees, making the program an ongoing program and directing 30 the department of administrative services to amend the 31 existing contract to continue the program beyond the original 32 pilot program repeal date of December 31, 2011. The bill 33 appropriates funds to the department of administrative services 34 for the purpose of the program. The bill takes effect upon 35 -3- LSB 2206SV (1) 84 pf/nh 3/ 4

S.F. 446 enactment. 1 -4- LSB 2206SV (1) 84 pf/nh 4/ 4