SB2656 SD2

SECTION 1. The legislature finds that according to recent data from the federal Centers for Disease Control and Prevention, more than twenty-three per cent of Americans use three or more prescription medications, while eleven per cent of Americans take five or more medications. Data from the Centers for Disease Control and Prevention also indicates that, although the treatment of patients with chronic diseases accounts for eighty-six per cent of the total health care spending in America, only fifty per cent of those on maintenance medications for chronic diseases adhere to their prescription therapies.

The legislature further finds that medication synchronization involves the coordination of a patient's medication refills, so that a patient who takes two or more maintenance medications for chronic conditions can refill the medications on the same schedule. Studies have shown that medication adherence is critical to long-term positive patient outcomes and that prescription medications are an important tool that can help manage chronic diseases. Medication synchronization improves patient health by: improving medication adherence rates; minimizing disruptions in treatment due to delayed or missed refills because of confusion regarding when a prescription is due; simplifying patient and caregiver routines by streamlining trips to the pharmacy; reducing costs to insurers; and promoting efficient workflow in pharmacies by allowing pharmacists and patients to work together to synchronize a patient's medications for pick-up on the same day each month.

The legislature additionally finds that more than twenty states have passed legislation that enables pharmacies and patients to work together with health care practitioners to synchronize medications.

Accordingly, the purpose of this Act is to allow the synchronization of plan participants' medications by requiring health plans, policies, contracts, or agreements that are offered by health insurers, mutual benefit societies, and health maintenance organizations and provide prescription drug benefits, to apply prorated daily cost-sharing rates for prescriptions dispensed by network pharmacies for less than a thirty-day supply.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"§431:10A- Medication synchronization; proration; dispensing fees. (a) Each individual or group policy of accident and health or sickness insurance that provides prescription drug coverage in the State shall permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty days' supply for the purpose of medication synchronization and for which the insured patient requests or agrees to less than a thirty-day supply.

(b) For purposes of this section, no insurer that provides prescription drug coverage shall deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensed amount is a partial supply for the purpose of medication synchronization and the insured patient requests or agrees to a partial supply.

(c) For the purposes of medication synchronization pursuant to subsection (a), each insurer shall allow a network pharmacy to override any denial codes indicating that a prescription is being refilled too soon.

(d) No policy providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copayment for the beneficiary or fee paid for medication synchronization services.

(e) A network pharmacy shall identify an anchor prescription to which all other prescriptions may be subject to medication synchronization; provided that any medication dispensed in an unbreakable package shall be considered the anchor prescription for purposes of this section.

(f) No schedule II narcotic controlled substance listed in section 329-16 shall be eligible for medication synchronization under this section.

(g) For purposes of this section:

"Medication synchronization" means the coordination of medication refills for an insured patient taking two or more medications for one or more chronic conditions that are being dispensed by a single contracted pharmacy, such that the patient's medications are refilled on the same schedule for a given time period for the purpose of improving medication adherence.

"Unbreakable package" means a medication form or package that is to be dispensed in its original container. The term unbreakable package includes but is not limited to eye drops, inhalers, creams, and ointments."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

"§432:1- Medication synchronization; proration; dispensing fees. (a) Each hospital or medical service plan contract that provides prescription drug coverage in the State shall permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty days' supply for the purpose of medication synchronization and for which the member patient requests or agrees to less than a thirty-day supply.

(b) For purposes of this section, no mutual benefit society that provides prescription drug coverage shall deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensed amount is a partial supply for the purpose of medication synchronization and the member patient requests or agrees to a partial supply.

(c) For the purposes of medication synchronization pursuant to subsection (a), each mutual benefit society shall allow a network pharmacy to override any denial codes indicating that a prescription is being refilled too soon.

(d) No plan contract providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copayment for the beneficiary or fee paid for medication synchronization services.

(f) No schedule II narcotic controlled substance listed in section 329-16 shall be eligible for medication synchronization under this section.

(g) For purposes of this section:

SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432D- Medication synchronization; proration; dispensing fees. (a) Each health maintenance organization policy, contract, plan, or agreement that provides prescription drug coverage in the State shall permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty days' supply for the purpose of medication synchronization and for which the enrollee patient requests or agrees to less than a thirty-day supply.

(b) For purposes of this section, no health maintenance organization that provides prescription drug coverage shall deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensed amount is a partial supply for the purpose of medication synchronization and the enrollee patient requests or agrees to a partial supply.

(c) For the purposes of medication synchronization pursuant to subsection (a), each health maintenance organization shall allow a network pharmacy to override any denial codes indicating that a prescription is being refilled too soon.

(d) No policy, contract, plan, or agreement providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copayment for the beneficiary or fee paid for medication synchronization services.

(f) No schedule II narcotic controlled substance listed in section 329-16 shall be eligible for medication synchronization under this section.

(g) For purposes of this section:

SECTION 5. Section 461-1, Hawaii Revised Statutes, is amended by amending the definition of "practice of pharmacy" to read as follows:

""Practice of pharmacy" means:

(1) The interpretation and evaluation of prescription orders; the compounding, dispensing, and labeling of drugs and devices (except labeling by a manufacturer, packer, or distributor of nonprescription drugs and commercially legend drugs and devices); the participation in drug selection and drug utilization reviews; the proper and safe storage of drugs and devices and the maintenance of proper records therefor; the responsibility for advising when necessary or where regulated, of therapeutic values, content, hazards, and use of drugs and devices; and the interpretation and evaluation of prescription orders to adjust the supply dispensed for purposes of conducting medical synchronization for the insured patient's medications;

(2) Performing the following procedures or functions as part of the care provided by and in concurrence with a "health care facility" and "health care service" as defined in section 323D-2, or a "pharmacy" or a licensed physician or a licensed advanced practice registered nurse with prescriptive authority, or a "managed care plan" as defined in section 432E-1, in accordance with policies, procedures, or protocols developed collaboratively by health professionals, including physicians and surgeons, pharmacists, and registered nurses, and for which a pharmacist has received appropriate training required by these policies, procedures, or protocols:

(A) Ordering or performing routine drug therapy related patient assessment procedures;

(B) Ordering drug therapy related laboratory tests;

(C) Initiating emergency contraception oral drug therapy in accordance with a written collaborative agreement approved by the board, between a licensed physician or advanced practice registered nurse with prescriptive authority and a pharmacist who has received appropriate training that includes programs approved by the American Council of Pharmaceutical Education (ACPE), curriculum-based programs from an ACPE-accredited college of pharmacy, state or local health department programs, or programs recognized by the board of pharmacy;

(D) Administering drugs orally, topically, by intranasal delivery, or by injection, pursuant to the order of the patient's licensed physician or advanced practice registered nurse with prescriptive authority, by a pharmacist having appropriate training that includes programs approved by the ACPE, curriculum-based programs from an ACPE-accredited college of pharmacy, state or local health department programs, or programs recognized by the board of pharmacy;

(E) Administering:

(i) Immunizations orally, by injection, or by intranasal delivery, to persons eighteen years of age or older by a pharmacist having appropriate training that includes programs approved by the ACPE, curriculum-based programs from an ACPE-accredited college of pharmacy, state or local health department programs, or programs recognized by the board of pharmacy;

(ii) Vaccines to persons between fourteen and seventeen years of age pursuant to section 461-11.4; and

(iii) Human papillomavirus, Tdap (tetanus, diphtheria, pertussis), meningococcal, and influenza vaccines to persons between eleven and seventeen years of age pursuant to section 461-11.4;

(F) As authorized by the written instructions of a licensed physician or advanced practice registered nurse with prescriptive authority, initiating or adjusting the drug regimen of a patient pursuant to an order or authorization made by the patient's licensed physician or advanced practice registered nurse with prescriptive authority and related to the condition for which the patient has been seen by the licensed physician or advanced practice registered nurse with prescriptive authority; provided that the pharmacist shall issue written notification to the patient's licensed physician or advanced practice registered nurse with prescriptive authority or enter the appropriate information in an electronic patient record system shared by the licensed physician or advanced practice registered nurse with prescriptive authority, within twenty-four hours;

(G) Transmitting a valid prescription to another pharmacist for the purpose of filling or dispensing;

(H) Providing consultation, information, or education to patients and health care professionals based on the pharmacist's training and for which no other licensure is required; or

(I) Dispensing an opioid antagonist in accordance with a written collaborative agreement approved by the board, between a licensed physician and a pharmacist who has received appropriate training that includes programs approved by the ACPE, curriculum-based programs from an ACPE-accredited college of pharmacy, state or local health department programs, or programs recognized by the board;

(3) The offering or performing of those acts, services, operations, or transactions necessary in the conduct, operation, management, and control of pharmacy; and

(4) Prescribing and dispensing contraceptive supplies pursuant to section 461-11.6."

SECTION 6. New statutory material is underscored.

SECTION 7. This Act shall take effect on July 1, 2050, and shall be repealed on July 1, 2023; provided that the definition of "practice of pharmacy" in section 461-1, Hawaii Revised Statutes, shall be reenacted in the form in which it read on the day prior to the effective date of this Act.

THE SENATE	S.B. NO.	2656
TWENTY-NINTH LEGISLATURE, 2018		S.D. 2
STATE OF HAWAII