SENATE FILE 446

BY  COMMITTEE ON STATE GOVERNMENT

(SUCCESSOR TO SSB 1125)

A BILL FOR

An Act relating to medication therapy management, providing an appropriation, and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

   Section 1.  NEW SECTION.  8A.440  Medication therapy management.
   1.  As used in this section unless the context otherwise requires:
   a.  “Eligible employee” means an employee of the state, with the exception of an employee of the state board of regents or institutions under the state board of regents, for whom group health plans are established pursuant to chapter 509A providing for third-party payment or prepayment for health or medical expenses.
   b.  “Medication therapy management” means a systematic process performed by a licensed pharmacist, designed to optimize therapeutic outcomes through improved medication use and reduced risk of adverse drug events, including all of the following services:
   (1)  A medication therapy review and in-person consultation relating to all medications, vitamins, and herbal supplements currently being taken by an eligible individual.
   (2)  A medication action plan, subject to the limitations specified in this section, communicated to the individual and the individual’s primary care physician or other appropriate prescriber to address safety issues, inconsistencies, duplicative therapy, omissions, and medication costs. The medication action plan may include recommendations to the prescriber for changes in drug therapy.
   (3)  Documentation and follow-up to ensure consistent levels of pharmacy services and positive outcomes.
   2.
  a.  The department shall amend the contract for the provision of medication therapy management services as initially required pursuant to 2010 Iowa Acts, chapter 1193, section 166, to provide for the continuation of medication therapy management services for eligible employees who meet any of the following criteria:
   (1)  An individual who takes four or more prescription drugs to treat or prevent two or more chronic medical conditions.
   (2)  An individual with a prescription drug therapy problem who is identified by the prescribing physician or other appropriate prescriber, and referred to a pharmacist for medication therapy management services.
   (3)  An individual who meets other criteria established by the third-party payment provider contract, policy, or plan.
   b.  The contract shall require the entity to provide annual reports to the general assembly detailing the costs, savings, estimated cost avoidance and return on investment, and patient outcomes related to the medication therapy management services provided. The entity shall guarantee demonstrated annual savings, including any savings associated with cost avoidance at least equal to the program’s costs with any shortfall amount refunded to the state. The contract shall include terms, conditions, and applicable measurement standards associated with the demonstration of savings. The department shall verify the demonstrated savings reported by the entity was achieved in accordance with the agreed upon measurement standards. The entity shall be prohibited from using the entity’s employees to provide the medication therapy management services and shall instead be required to contract with licensed pharmacies, pharmacists, or physicians.
   c.  The department may establish an advisory committee comprised of an equal number of physicians and pharmacists to provide advice and oversight in evaluating the results of the program. The department shall appoint the members of the advisory committee based upon designees of the Iowa pharmacy association, the Iowa medical society, and the Iowa osteopathic medical association.
   d.  The fees for pharmacist-delivered medication therapy management services shall be separate from the reimbursement for prescription drug product or dispensing services; shall be determined by each third-party payment provider contract, policy, or plan; and must be reasonable based on the resources and time required to provide the service.
   e.  A fee shall be established for physician reimbursement for services delivered for medication therapy management as determined by each third-party payment provider contract, policy, or plan, and must be reasonable based on the resources and time required to provide the service.
   f.  If any part of the medication therapy management plan developed by a pharmacist incorporates services which are outside the pharmacist’s independent scope of practice including the initiation of therapy, modification of dosages, therapeutic interchange, or changes in drug therapy, the express authorization of the individual’s physician or other appropriate prescriber is required.
   Sec. 2.  APPROPRIATION —— DEPARTMENT OF ADMINISTRATIVE SERVICES.  There is appropriated from the general fund of the state to the department of administrative services for the fiscal year beginning July 1, 2011, and ending June 30, 2012, the following amount or so much thereof as is necessary, to be used for the purpose specified:

   For the medication therapy management program as enacted in this Act:
.................................................. $    481,000
   Sec. 3.  REPEAL.  2010 Iowa Acts, chapter 1193, section 166, is repealed.
   Sec. 4.  EFFECTIVE UPON ENACTMENT.  This Act, being deemed of immediate importance, takes effect upon enactment.
EXPLANATION
   This bill relates to medication therapy management. The bill codifies the pilot program for medication therapy management implemented on July 1, 2010, for eligible state employees, making the program an ongoing program and directing the department of administrative services to amend the existing contract to continue the program beyond the original pilot program repeal date of December 31, 2011. The bill appropriates funds to the department of administrative services for the purpose of the program. The bill takes effect upon enactment.