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JSB Attorneys, PLLC



Kentucky Legislation (House Bill 48) Reimbursement for Pharmaceutical Services, effective 6/28/21

 Creates a new section of Subtitle 12 of KRS Chapter 304 to establish certain insurance practices relating to the reimbursement of pharmacists;

 Amends KRS 304.14-135 to establish a clean claim form for the reimbursement of certain pharmacist services or procedures;

 Amends KRS 304.17A-844 and 304.17B-011 to conform;

 Amends KRS 18A.225 to require the state employee health plan to comply with pharmacist reimbursement requirements; and

 Amends KRS 342.020 (Workers’ Compensation Statute) to require workers' compensation employers, insurers, and payment obligors to comply with pharmacist reimbursement requirements.

     o Section (14) was added to KRS 342.020. Medical treatment.

          (14)(a) As used in this subsection, "practice of pharmacy" has the same meaning as in KRS 315.010.     

             (b) In addition to all other compensation that may be reimbursed to a pharmacist under this chapter, the employer, insurer, or payment obligor shall be liable for the reimbursement of a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service or procedure:

                         1. Is within the scope of the practice of pharmacy;

                         2. Would otherwise be compensable under this chapter if the service or procedure were provided by a:

                                a. Physician;

                                 b. Advanced practice registered nurse; or

                                 c. Physician assistant; and

                         3. Is performed by the pharmacist in strict compliance with laws and administrative regulations related to the pharmacist's license.

    o KRS 315 is titled Pharmacists and Pharmacies. KRS 315.010 defines “practice of pharmacy” as follows:

              "Practice of pharmacy" means interpretation, evaluation, and implementation of medical orders and prescription drug orders; responsibility for dispensing prescription drug orders, including radioactive substances; participation in drug and drug-related device selection; administration of medications or biologics in the course of dispensing or maintaining a prescription drug order; the administration of adult immunizations pursuant to prescriberapproved protocols; the administration of immunizations to individuals nine (9) to seventeen (17) years of age pursuant to prescriber-approved protocols with the consent of a parent or guardian; the administration of immunizations to a child as defined in KRS 214.032, pursuant to protocols as authorized by KRS 315.500; drug evaluation, utilization, or regimen review; maintenance of patient pharmacy records; and provision of patient counseling and those professional acts, professional decisions, or professional services necessary to maintain and manage all areas of a patient's pharmacy-related care, including pharmacy-related primary care as defined in this section;

o Therefore, HB 48 amends KRS 342.020 to require employer/insurers to reimburse pharmacists for services provided if they fall within the scope of the “practice of pharmacy” definition above and would otherwise be compensable if provided by a physician, advanced practice registered nurse, or physician assistant. Also the service must be performed in strict compliance with the laws and administrative regulations related to the pharmacist’s license.

Should you have any questions or wish to discuss any of these matters personally, please contact us at your convenience.

H. Douglas Jones, Esq.

Margo J. Menefee, Esq.