HCS HB 1327 -- PHARMACIST SERVICE PAYMENTS

SPONSOR:  Reynolds

COMMITTEE ACTION:  Voted "do pass" by the Committee on Social
Services, Medicaid and the Elderly by a vote of 15 to 2.

This substitute requires the Department of Social Services to
pay for dispensing and pharmacy services to any pharmacy which
has a valid Medicaid provider agreement with the department, and
to issue regulations for the establishment of such fees.  These
fees must comply with the standards issued by the American
Institute of Certified Public Accountants, and equal or exceed
the pharmacy's costs in providing the dispensing and pharmacy
services.  The department is required to reevaluate the amount
of the fee at least once every 2 years, but no more than once a
year.  This bill also prohibits health insurance plans which
provide pharmaceutical benefits from paying dispensing and
pharmacy fees at a rate lower than that paid by the Department
of Social Services for the same services.  Policies, contracts,
and plans may not allow or mandate differences in coverage or
conditions, including copayment fees, whether the prescriptions
are obtained through direct pharmacy contact or through an out--
of-state mail order pharmacy, as long as the provider is a
participant in the plan.

FISCAL NOTE:  Not available at time of printing.

PROPONENTS:  Supporters say that the bill allows independent
pharmacists a chance to compete with franchises and chain
pharmacies.

Testifying for the bill were Representative Reynolds; Missouri
Society of Pharmacy Law; and Missouri Pharmacy Association.

OPPONENTS:  There was no opposition voiced to the committee.

Debra Cheshier, Senior Legislative Analyst

HB 1327 -- Pharmacist Service Payments

Sponsor:  Reynolds

This bill requires the Department of Social Services to pay for
dispensing and pharmacy services to any pharmacy which has a
valid Medicaid provider agreement with the department, and to
issue regulations for the establishment of such fees.  These
fees must comply with the standards issued by the American
Institute of Certified Public Accountants, equal or exceed the
pharmacy's dispensing fee in effect on January 1, 1998, and
equal or exceed the pharmacy's costs in providing the dispensing
and pharmacy services.  The department is required to reevaluate
the amount of the fee at least once every 2 years, but no more
than once a year, and may not decrease the amount of the fee.
This bill also prohibits health insurance plans which provide
pharmaceutical benefits from paying dispensing and pharmacy fees
at a rate lower than that paid by the Department of Social
Services for the same services.  Health insurance plans in
effect on or after August 28, 1998, that contract for pharmacy
network services must allow the participation of any licensed
pharmacy in the state, under the same terms and conditions as
those offered to other providers of pharmacy services.  These
plans may not allow or mandate differences in coverage or
conditions, including copayment fees, whether the prescriptions
are obtained through direct pharmacy contact or through an out--
of-state mail order pharmacy, as long as the provider is a
participant in the plan.