Reimbursement for pharmacist services.

Assembly Member Flora proposes equalizing Medi-Cal reimbursement rates between pharmacists and physicians while expanding payment requirements for health plans and insurers. The legislation would modify the current 85% reimbursement rate for pharmacist services to match physician fee schedules, including medication therapy management services.

The bill requires health care service plans and disability insurers to reimburse services provided by pharmacists enrolled as plan providers, provided the services fall within their scope of practice and the plans cover similar services by other licensed providers. For Medi-Cal, the Department of Health Care Services must implement a medication therapy management reimbursement system specifically for specialty drug categories, with payments limited to eligible pharmacists and pharmacies.

Covered pharmacist services under Medi-Cal include furnishing travel medications, naloxone, contraception, immunizations, tobacco cessation treatment, HIV prophylaxis medications, and medication therapy management for specialty drugs. Pharmacists must enroll as ordering, referring, and prescribing providers before submitting claims. Implementation requires federal approval and remains contingent on available federal matching funds.

The measure contains provisions making willful violations by health plans a criminal offense, though it specifies that no state reimbursement is required for local agencies to implement these changes. The Department may initially implement the provisions through administrative guidance while formal regulations are developed.