Legislation attains provider status for pharmacists

Introduced February 14, 2020, Senate Bill 787 provides benefits to pharmacists for care rendered within the pharmacist’s scope of practice if such benefits would ordinarily be paid if the service was performed by another health care provider.

This is a new section of Chapter 33-53-1 — referred to as “provider status.”

(a) For health plans issued or renewed on or after January 1, 2021;

(1) Benefits may not be denied for any health care service performed by a pharmacist licensed under Chapter 30-5-1 if:

(A) The service performed was within the lawful scope of the pharmacist’s license;

(B) The plan would have provided benefits if the service had been performed by another health care provider; and

(C) The pharmacist is included in the plan’s network of participating providers.

(2) The health plan shall include an adequate number of pharmacists in its network of participation health care providers.

(b) The participation of pharmacies in the plan network’s drug benefit does not satisfy the requirement that plans include pharmacists in their network of participating health care providers.

(c) For health benefit plans, issued or renewed on or after January 1, 2020, but before January 1, 2021, that delegate credentialing agreements to contracted health care facilities, shall accept credentialing for pharmacists employed or contracted by those facilities. Health plans shall reimburse facilities for covered services provided by network pharmacists within the pharmacists’ of practice per negotiations with the facility.