HB 4430

Abstract

Amends the Pharmacy Practice Act. Provides that the definition of "practice of pharmacy" includes the initiation, dispensing, or administration of drugs, laboratory tests, assessments, referrals, and consultations for human immunodeficiency virus pre-exposure prophylaxis and human immunodeficiency virus post-exposure prophylaxis. Provides that as applicable to the State's Medicaid program and other payers, patient care services ordered and administered by a pharmacist shall be covered and reimbursed at no less than 85% of the rate that the services are covered and reimbursed when ordered or administered by physicians. Provides that a pharmacist shall provide patient care services for human immunodeficiency virus pre-exposure prophylaxis and human immunodeficiency virus post-exposure prophylaxis to a patient after satisfying specified requirements. Amends the Illinois Public Aid Code. Provides that specified provisions concerning coverage of patient care services provided by a pharmacist shall apply to all patient care services provided by a pharmacist (rather than patient care services for hormonal contraceptives assessment and consultation only). Effective immediately. House Floor Amendment No. 1 Deletes reference to: 225 ILCS 85/43 Adds reference to: 210 ILCS 25/7-101 from Ch. 111 1/2, par. 627-101 210 ILCS 25/7-102 from Ch. 111 1/2, par. 627-102 215 ILCS 5/356z.1a new 225 ILCS 85/9 from Ch. 111, par. 4129 225 ILCS 85/43.5 new Replaces everything after the enacting clause. Amends the Pharmacy Practice Act. Provides that in accordance with a standing order by a physician licensed to practice medicine in all its branches or the medical director of a county or local health department, a pharmacist may provide patients with prophylaxis drugs for human immunodeficiency virus pre-exposure prophylaxis or post-exposure prophylaxis. Provides that a pharmacist may provide initial assessment and dispensing of prophylaxis drugs for human immunodeficiency virus pre-exposure prophylaxis or post-exposure prophylaxis. Contains requirements for the standing order. Provides that a pharmacist must communicate the services provided under the provisions to the patient and the patient's primary health care provider or other health care professional or clinic, if known. Provides that if there is no primary health care provider provided by the patient, then the pharmacist must give a list of primary health care providers or clinics in the area. Provides that a pharmacist shall complete an educational training program accredited by the Accreditation Council for Pharmacy Education or Department of Financial and Professional Regulation related to human immunodeficiency virus pre-exposure prophylaxis and human immunodeficiency virus post-exposure prophylaxis. Makes conforming and other changes. Makes corresponding changes in the Illinois Clinical Laboratory and Blood Bank Act. Amends the Illinois Insurance Code. Provides that an insurance carrier or third-party payor shall reimburse a pharmacist or other health care professional for dispensing HIV prophylaxis medications and providing other services to a covered person in accordance with the current version of the guidelines of the Centers for Disease Control and Prevention and the United States Preventive Services Task Force. Provides that reimbursement shall provide an adequate consultation fee or, if medical billing is not available, an enhanced dispensing fee that is equivalent to 85% of the fees for services provided by an advanced practice registered nurse or physician. Amends the Illinois Public Aid Code. Provides that services provided by the pharmacist under the provisions concerning HIV prophylaxis in the Pharmacy Practice Act shall be covered and reimbursed at no less than 85% of the rate that the services are reimbursed when provided by a physician. Makes other changes. Effective January 1, 2023. Senate Committee Amendment No. 1 Deletes reference to: 215 ILCS 5/356z.1a new Adds reference to: 215 ILCS 5/356z.45 Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2023 shall provide coverage for health care or patient care services provided by a pharmacist if the pharmacist meets the requirements and scope of practice as set forth in provisions concerning HIV prophylaxis of the Pharmacy Practice Act (instead of a provision providing that an insurance carrier or third-party payor shall reimburse a pharmacist or other health care professional for dispensing HIV prophylaxis drugs and providing services under provisions concerning HIV prophylaxis of the Pharmacy Practice Act to a covered person in accordance with the current version of the guidelines of the Centers for Disease Control and Prevention and the United States Preventive Services Task Force).