Senate Bill 787 passed the 2020 West Virginia Legislature by adding a new section, designated Chapter 33-53-1, relating to providing benefits to pharmacists for pharmacist care rendered within the pharmacist’s scope of practice if benefits would be provided for such services performed by other health care providers.
Benefits may not be denied for any health care service performed by a pharmacist licensed under Chapter 33-5-1, if:
- The service performed was within the lawful scope of the pharmacist’s license;
- The plan would have provided benefits if the service has been performed by another healthcare provider; and
- The pharmacist is included in the plan’s network of participating providers.
The health plan shall include an adequate number of pharmacists in its network of participating health care providers.
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.
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 with the pharmacists’ scope of practice per negotiations wit the facility.
For purposes of this new law, health plans, policies, contracts or agreements do not include Medicaid or Children’s Health Insurance Program health plans, policies, contracts or agreements that are approved by the Department of Health and Human Resources Bureau of Medical Services (Medicaid).