New Mexico Bill Requires Parity Reimbursement for Pharmacy Services

The New Mexico House and Senate recently passed a bill that requires insurance companies to reimburse pharmacists who provide clinical services and prescribe medications.¹

House Bill 42 (HB42), also known as the Pharmaceutical Services Reimbursement Parity bill, cleared the House Health and Human Services Committee on a 5-2 vote.²

“The pharmacy community has worked to get reimbursement for providing clinical services for decades with some limited success. Those successes were limited to specific clinical services provided by pharmacists, such as administration fees for vaccinations. A few are connected to contracted programs providing MTM which impact a few pharmacists and their services,” said R. Dale Tinker, FFSMB, executive director and association lobbyist for the New Mexico Pharmacists Association, in an email with Pharmacy Times.³

Rep. Debbie Armstrong (D-Albuquerque), introduced the bill. According to Armstrong, pharmacists can currently be reimbursed for the cost of medication and for filling prescriptions but not for clinical and prescriptive services.⁴

However, the bill states that group health plans would not be able to discriminate with respect to reimbursement under the group health plan against a certified pharmacist clinician or pharmacist certified to provide a prescriptive authority service who is acting within the scope of certification.¹

According to Tinker, HB42 provides a formal reimbursement structure that recognizes clinical pharmacists’ services. The bill requires all health plans in New Mexico to adopt a structure providing for parity in reimbursing pharmacist clinical services, provided by pharmacists with prescribing authority, at an amount similar to others providing those clinical services, such as physicians and nurse practitioners.³

New Mexico has advanced practice pharmacists, called pharmacist clinicians, and pharmacists who can prescribe using protocols approved by the New Mexico Board of Medicine, Board of Nursing, and Board of Pharmacy. Currently, the 3 boards have approved protocols for immunizations, emergency contraception, tobacco cessation, tuberculosis testing, naloxone prescribing, and hormonal contraception.³

“Very few states recognize the clinical services provided by pharmacists and this legislation provides the next step in national recognition for pharmacists providing clinical services to their patients by including reimbursement to pharmacist practitioners,” Tinker said to Pharmacy Times.³

Joseph R. Anderson, PharmD, PhC, BCPS, assistant dean for Curricular Affairs for the University of New Mexico College of Pharmacy, told Pharmacy Times by email that teamwork amongst various pharmacy stakeholders was essential to passing this legislation. “First and foremost, the work done by Representative Debbie Armstrong in sponsoring the legislation and Dale Tinker, executive director of the New Mexico Pharmacists Association. Along with those individuals, my colleague, Dr. Melanie Dodd and I served as expert witnesses in the various committees that the bill was heard in the House and Senate.”⁴

He added that the additional grassroots effort was critically valuable, led by Dean Don Godwin and the students at the college of pharmacy. These individuals created a phone bank to call each representative and senator to urge their support. Additionally, the New Mexico Society of Health-System Pharmacists sent out legislative updates and encouraged their membership to call their legislator. The American Society of Health-System Pharmacists also sent a letter of support that was co-signed by nearly every professional pharmacy organization to the governor and to the chair of each committee to whom the bill was presented.⁴

Reference

• Bill Text: NM HB42. Legiscan website. https://www.legiscan.com/NM/text/HB42/2020. Accessed February 26, 2020.
• FDA and Pharmacy Weekly Digest. JDSUPRA website. February 26, 2020. https://www.jdsupra.com/legalnews/fda-and-pharmacy-weekly-digest-february-43628/. Accessed February 26, 2020.
• Interview with Dale Tinker. Email. February 26, 2020.
• Legislative Roundup. Santa Fe New Mexican. Published January 28, 2020. https://www.santafenewmexican.com/news/legislature/legislative-roundup-jan/article_26fa762a-411b-11ea-85c3-b3398da03048.html. Accessed February 26, 2020.
• Interview with Joe R. Anderson, PharmD, PhC, BCPS. Email. February 27, 2020.