Introduced Version
Senate Bill 148 History
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Key: Green = existing Code. Red = new code to be enacted
Senate Bill No. 148
(By Senator Yost)
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[Introduced February 14, 2013; referred to the Committee on
Health and Human Resources; and then to the Committee on
Finance.]
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A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new article, designated §16-45-1, §16-45-2,
§16-45-3, §16-45-4, §16-45-5 and §16-45-6, all relating to
creating the Medication Therapy Management Act; and specifying
that fees for third-party providers pay for the therapy under
this act.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §16-45-1, §16-45-2,
§16-45-3, §16-45-4, §16-45-5 and §16-45-6, all to read as follows:
ARTICLE 45. MEDICATION THERAPY MANAGEMENT ACT.
§16-45-1. Medication therapy management program.
A medication therapy management program defined in this article is a program of drug therapy management furnished by a duly
licensed pharmacist under the West Virginia Code, and that is
designed to assure, with respect to targeted patients, that
medications are appropriately used to optimize therapeutic outcomes
through improved medication use, and to reduce the risk of adverse
events, including adverse drug interactions. Such a program may
distinguish between services in ambulatory and institutional
settings. Upon implementation, third-party providers and state
health care providers shall pay a fee to pharmacy providers for
medication therapy management services. Targeted patients are
individuals who have at least one chronic disease, including, but
not limited to, diabetes, asthma, chronic obstructive pulmonary
disease or other chronic lung disorders, hypertension,
hyperlipidemia, congestive heart failure, chronic pain disorder or
behavioral health disorder, and are taking multiple drugs to treat
one or more such conditions. A patient with a prescription drug
therapy problem who is identified by the primary health care
provider and is eligible for medication therapy management services
under the plan may self-pay.
§16-45-2. Definition.
For purpose of this article:
"Medication therapy management" means the one-on-one provision
of the following pharmaceutical care services by a licensed pharmacist to optimize the therapeutic outcomes of the patient's
medications. Working with the patient to develop a personal
medication record as part of a personal health record that contains
all prescription and nonprescription drugs, herbal products, and
dietary supplements taken by the patient.
§16-45-3. Patient treatment.
"Medication therapy management" may include:
(a) Interviewing the patient to gather data, including
demographic information, general health and activity status,
medical history, medication history, immunization history, and to
collect the patient's personal assessment about his or her disease
or condition and medication use;
(b) Performing necessary clinical assessments of the patient's
health status, including current or previous diseases or
conditions;
(c) Assessing patient values, preferences, quality of life,
goals of therapy, cultural issues, education level, language
barriers, literacy level and other characteristics affecting the
patient's communication skills that could affect patient outcomes;
(d) Monitoring and evaluating the patient's responses to his
or her medication therapies, including the safety and effectiveness
of those therapies;
(e) Assessing, identifying, prioritizing and developing a plan for resolving medication-related problems related to the clinical
appropriateness of each medication, the appropriateness of the
dosage of each medication, including considerations of indications,
contraindications, and potential adverse effects, adherence to
regimen, untreated diseases or conditions, medication costs, and
provider access considerations;
(f) Providing consultative services for the patient,
intervening to address medication-related issues, and, when the
pharmacist believes it will be beneficial to the patient's health,
referring the patient to his or her regular health care provider
for evaluation and additional referral(s);
(g) Communicating information to the primary health care
provider or other health care professionals, including consultation
on the selection of medications, suggestions to address identified
medication problems, updates on the patient's progress, and
recommended follow-up care;
(h) Providing education and training on the appropriate use of
medications and monitoring devices;
(i) Coaching patients to manage their own medications and
promote their wellness;
(j) Evaluating the patient's ability to detect symptoms that
could be attributed to adverse reactions or interactions from
medications;
(k) Monitoring, and assessing the results of a patient's
laboratory testing, including those performed in the pharmacy
setting;
(l) Increasing patient adherence to prescription medication
regimens through medication refill reminders, compliance aids (such
as pill boxes, timers, packaging, and calendaring, and other
appropriate and cost-effective interventions);
(m) Detection of adverse drug events, as well as overuse and
underuse of prescription and nonprescription products;
(n) Coordinating and integrating medication therapy management
services within the broader health care management services being
provided to the patient as recommended by the primary healthcare
provider and/or other healthcare professional or specialist;
(o) Performing follow-up medication therapy management
services for the maintenance and support of the patient, as
recommended by the primary health care provider or other health
care professional or specialist, or both; and
(p) Maintaining all necessary documentation, including the
following and any other records required for compliance with state
and federal laws and regulations pertaining to maintenance of
patient records:
(1) Patient demographics and basic identifying information;
(2) Subjective, patient-reported, information;
(3) Objective, service provider-based, observations regarding
known allergies, diseases, conditions, laboratory test results,
vital signs, physical exam results, review of systems, and recorded
medical diagnoses;
(4) Assessment of medication-related problems;
(5) Written care plan;
(6) Recorded collaborative communication with primary health
care providers and other healthcare professionals;
(7) Patient-specific lists of actions to be followed in
tracking progress in medication self-management;
(8) Any relevant transition plan or scheduling of follow-up
visits and billing information, including level of patient care,
level of complexity and charges;
(9) Patient health and medication literacy assessment; and
(10) Patient's pharmacy encounter satisfaction survey.
(q) Providing the individual with a written or printed summary
of the results of such medication therapy management review
session.
§16-45-4. Reimbursement eligibility.
To be eligible for reimbursement for services provided under
this article, a pharmacist shall:
(a) Hold a valid and current license issued by the West
Virginia Board of Pharmacy;
(b) Have completed a structured and comprehensive education
program approved by the West Virginia Board of Pharmacy or the
American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has
both clinical and didactic elements;
(c) Develop a structured written patient care process
protocol; and
(d) Maintain an electronic patient record system for outcomes
analysis and patient care.
§16-45-5. Evaluation.
The Board of Pharmacy shall evaluate the effect of medication
therapy management on quality of care, patient outcomes, and
program costs, and shall include a description of any savings
generated in the medical assistance and general assistance medical
care programs that can be attributable to this coverage. The
evaluation shall be submitted to the Legislature within two years
of the effective date of the legislation.
§16-45-6. Payment of fees.
(a) Upon implementation of this legislation, third-party
providers shall pay a fee to pharmacy providers for medication
therapy management services. These services may also be provided by
pharmacists on a self-pay basis when a patient does not have a
third-party provider.
(b) The fee shall be calculated using one or more quarter-
hourly rates implemented by formal regulation that are designed to
reimburse the pharmacist or pharmacy based on time spent in
providing the medication therapy management services.
(c) Third-Party Plans shall pay the fee, separate from
reimbursement for prescription drug product or dispensing services,
to any individual pharmacist or pharmacy participating in the plans
that provides medication therapy management services.
NOTE: The purpose of this bill is to create a medication
management therapy program and setting out the funding source for
paying for the program.
The article is new; therefore, strike-throughs and
underscoring have been omitted.