2024 -- S 2617

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LC005220

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PHARMACIES

     Introduced By: Senators Valverde, Miller, Murray, and Lauria

     Date Introduced: March 01, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 5-19.1 of the General Laws entitled "Pharmacies" is hereby amended

by adding thereto the following section:

     5-19.1-36. Tobacco cessation therapy prescriptive authority.

     (a) A pharmacist who is licensed pursuant to this chapter and who meets the requirements

of this section may prescribe and dispense FDA-approved tobacco cessation drug therapies to a

qualified patient pursuant to rules and regulations adopted by the board of pharmacy, subject to the

approval of the director of health in consultation with the director of behavioral healthcare,

developmental disabilities and hospitals.

     (b) For the purposes of this section, "qualified patient" means a patient who:

     (1) Is at least eighteen (18) years of age; or of minimum age based on the most recent

guidance provided by the FDA;

     (2) Is willing to participate in a structured tobacco cessation program consisting of an initial

evaluation and appropriate follow-up visits with the pharmacist prescribing tobacco cessation

products; and

     (3) Has been educated on symptoms of nicotine toxicity, common and/or severe adverse

effects of prescribed medication(s), and when to seek medical treatment.

     (c) Prior to prescribing tobacco cessation therapies, the pharmacist shall have completed

tobacco cessation education approved by the state board of pharmacy.

     (d) The pharmacist shall refer or consult prior to prescribing regarding high-risk patients

or patients with an identified contraindication to FDA-approved tobacco cessation drug therapies

to the patient's primary care provider, as applicable, or to another provider, as appropriate.

     (e) All pharmacists participating in prescribing therapy for tobacco cessation shall follow

the most updated guidelines and standards of care as approved by the board of pharmacy, subject

to the approval of the director of health in consultation with the director of behavioral healthcare,

developmental disabilities and hospitals.

     (1) Pharmacists shall implement the most updated clinical practice guidelines to help

patients quit using all forms of tobacco.

     (2) Pharmacists' services shall include an educational component to include counseling on

medication therapies and cessation strategies as well as referral to sources provided by the Rhode

Island department of health.

     (f) Notification of the patient screening, the prescription record and the follow-up care plan

shall be provided to the patient's primary care provider, as applicable, within five (5) business days

following the prescribing of a tobacco cessation product.

     (g) The definition of a qualified patient is subject to adaptation pursuant to rules and

regulations adopted by the board of pharmacy, subject to the approval of the director of health in

consultation with the director of behavioral healthcare, developmental disabilities and hospitals.

     (h) Tobacco cessation drug therapies shall be covered by all health insurance companies

doing business in the State of Rhode Island.

     (i) Tobacco cessation drug therapies shall be covered by Medicaid upon approval of the

Medicaid section 1115 demonstration waiver to be submitted by the secretary of the executive

office of health and human services pursuant to chapter 12.4 of title 42.

     (j) All state and federal laws governing insurance coverage of tobacco cessation devices,

products and services shall apply to tobacco cessation prescribed by a pharmacist under this section.

     (k) Any individual health plan or group health plan and any health coverage through any

commercial health plan shall cover tobacco cessation products that are prescribed and dispensed

by a pharmacist, including counseling, if those tobacco cessation products would otherwise be

covered if prescribed by another type of health care provider.

     SECTION 2. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

Policies" is hereby amended by adding thereto the following sections:

     27-18-95. Mandatory coverage for tobacco cessation drug therapies.

     Every group health insurance contract, or medical expense insurance policy, plan or group

policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or

after January 1, 2025, shall provide coverage for tobacco cessation drug therapy.

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     27-18-96. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services

within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have

provided coverage if the service had been performed by a physician, advanced practice nurse, or

physician assistant. No nonprofit medical service corporation may require supervision, signature,

or referral by any other healthcare provider as a condition of reimbursement to a pharmacist;

provided that, no nonprofit medical service corporation may be required to pay for duplicative

services actually rendered by both a pharmacist and any other healthcare provider.

     (b) The health plan must include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

does not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

     (c) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer's provider

network where it can be established that the required services are not available from a provider in

the health insurer's network.

     SECTION 3. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following sections:

     27-19-87. Mandatory coverage for tobacco cessation drug therapies.

     Every group health insurance contract, or medical expense insurance policy, plan or group

policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or

after January 1, 2025, shall provide coverage for tobacco cessation drug therapy.

     27-19-88. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services

within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have

provided coverage if the service had been performed by a physician, advanced practice nurse, or

physician assistant. No nonprofit medical service corporation may require supervision, signature,

or referral by any other healthcare provider as a condition of reimbursement to a pharmacist;

provided that, no nonprofit medical service corporation may be required to pay for duplicative

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services actually rendered by both a pharmacist and any other healthcare provider.

     (b) The health plan must include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

does not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

     (c) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer's provider

network where it can be established that the required services are not available from a provider in

the health insurer's network.

     SECTION 4. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following sections:

     27-20-83. Mandatory coverage for tobacco cessation drug therapies.

     Every group health insurance contract, or medical expense insurance policy, plan or group

policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or

after January 1, 2025, shall provide coverage for tobacco cessation drug therapy.

     27-20-84. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services

within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have

provided coverage if the service had been performed by a physician, advanced practice nurse, or

physician assistant. No nonprofit medical service corporation may require supervision, signature,

or referral by any other healthcare provider as a condition of reimbursement to a pharmacist;

provided that, no nonprofit medical service corporation may be required to pay for duplicative

services actually rendered by both a pharmacist and any other healthcare provider.

     (b) The health plan must include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

does not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

     (c) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer's provider

network where it can be established that the required services are not available from a provider in

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the health insurer's network.

     SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following sections:

     27-41-100. Mandatory coverage for tobacco cessation drug therapies.

     Every group health insurance contract, or medical expense insurance policy, plan or group

policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or

after January 1, 2025, shall provide coverage for tobacco cessation drug therapy.

     27-41-101. Coverage for pharmacists' services.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2025, shall provide coverage for the services

within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have

provided coverage if the service had been performed by a physician, advanced practice nurse, or

physician assistant. No nonprofit medical service corporation may require supervision, signature,

or referral by any other healthcare provider as a condition of reimbursement to a pharmacist;

provided that, no nonprofit medical service corporation may be required to pay for duplicative

services actually rendered by both a pharmacist and any other healthcare provider.

     (b) The health plan must include an adequate number of pharmacists in its network of

participating medical providers. The participation of pharmacies in the plan network's drug benefit

does not satisfy the requirement that plans include pharmacists in their networks of participating

medical providers.

     (c) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer's provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer's provider

network where it can be established that the required services are not available from a provider in

the health insurer's network.

     SECTION 6. Rhode Island Medicaid Reform Act of 2008 Resolution.

     WHEREAS, The General Assembly enacted Chapter 12.4 of Title 42 entitled “The Rhode

Island Medicaid Reform Act of 2008”; and

     WHEREAS, A legislative enactment is required pursuant to Rhode Island General Laws

42-12.4-1, et seq.; and

     WHEREAS, Rhode Island General Laws § 42-7.2-5(3)(i) provides that the Secretary of

the Executive Office of Health and Human Services (“Executive Office”) is responsible for the

review and coordination of any Medicaid section 1115 demonstration waiver requests and renewals

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as well as any initiatives and proposals requiring amendments to the Medicaid state plan or category

II or III changes as described in the demonstration, “with potential to affect the scope, amount, or

duration of publicly-funded health care services, provider payments or reimbursements, or access

to or the availability of benefits and services provided by Rhode Island general and public laws”;

and

     WHEREAS, Implementation of adjustments may require amendments to the Rhode

Island’s Medicaid state plan and/or section 1115 waiver under the terms and conditions of the

demonstration. Further, adoption of new or amended rules, regulations and procedures may also be

required to allow a pharmacist to prescribe tobacco cessation therapies; now, therefore be it

     RESOLVED, That this General Assembly hereby approves the proposal stated above; and

be it further

     RESOLVED, That the Secretary of the Executive Office of Health and Human Services is

hereby authorized and directed to pursue and implement any waiver amendments, state plan

amendment, and/or changes to the applicable department's rules, regulations and procedures

approved herein and as authorized by Chapter 12.4 of Title 42 as soon as practicable; and be it

further

     RESOLVED, That this Joint Resolution shall take effect on July 1, 2024.

     SECTION 7. Section 1 of this act shall take effect on January 1, 2025 and sections 2

through 6 shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PHARMACIES

***

     This act would add a new section which sets forth conditions for pharmacists to prescribe

tobacco cessation drug therapies, including education approved by the state board of pharmacy.

The cessation therapies would be covered by all health insurance carriers on or after January 1,

2025.

     Section 1 of this act would take effect on January 1, 2025 and sections 2 through 6 would

take effect upon passage.

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LC005220

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