2025 -- H 5854

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LC001383

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PHARMACIES

     Introduced By: Representatives Tanzi, McGaw, Fogarty, Ajello, Kislak, Hull, Morales,
Potter, Bennett, and Cortvriend

     Date Introduced: February 28, 2025

     Referred To: House 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:

     5-19.1-37. 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

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 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.

     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, 2026, shall provide coverage for tobacco cessation drug therapy.

     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, 2026, 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;

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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 shall 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 section shall 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 section 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, 2026, 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, 2026, 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 shall 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 section shall 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 section outside of the health insurer's provider

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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, 2026, 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, 2026, 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 shall 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 section shall 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 section 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 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, 2026, shall provide coverage for tobacco cessation drug therapy.

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

LC001383 - Page 4 of 6

     (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, 2026, 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 shall 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 section shall 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 section 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. This act shall take effect upon passage.

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LC001383

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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 new sections which set 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,

2026.

     This act would take effect upon passage.

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LC001383

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