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Committee backs bill to let pharmacists bill medical benefit, but leaves details to payers
Summary
The committee passed SB 12 45 SD2 HD1 with amendments aimed at enabling pharmacists to be reimbursed for clinical services and to access payer networks when they meet credentialing standards, supporters said the bill could expand access and reduce costs while payers sought clarifications.
The House Committee on Consumer Protection and Commerce voted to pass SB 12 45 SD2 HD1 with amendments after testimony from health systems, colleges of pharmacy, pharmacy associations and the Department of Health.
Ray Matsumoto, dean at the Daniel K. Inouye College of Pharmacy, testified the bill would help recruit and retain pharmacists and improve access to chronic disease management, saying it would “allow pharmacists to be able to get reimbursed for clinical services that they are already trained and licensed to provide.” The University of Hawaii College of Pharmacy and the Board of Pharmacy testified in support.
Corey Sanders, director of the Hawaii Pharmacists Association, proposed amendments aimed at ensuring payers cannot deny benefits when a licensed pharmacist provides services under chapter 461 (the pharmacy practice act) and that pharmacists may contract with plans if they meet standard credentialing requirements. Sanders told the committee those credentialing standards can vary by setting and should generally be left to payers to determine.
Karen Pellegrut, a faculty member at the Daniel K. Inouye College of Pharmacy, cited results from a federally funded program in which pharmacists managing high‑risk patients statewide reportedly achieved a 264% return on investment and strong patient satisfaction (92% reported improved health and 100% said the services helped keep them out of the hospital). Pharmacy students and faculty also testified about workforce retention concerns and the value of leveraging pharmacists in team‑based care.
Members questioned whether the bill would require payers to accept pharmacists and whether credentialing and contracting hurdles would persist. Supporters said one amendment prohibits plans from denying a pharmacist the ability to contract if standard credentialing requirements are met; however, the bill does not compel payers to adopt payment rates.
After discussion the committee adopted amendments proposed by the Hawaii Pharmacists Association and advanced SB 12 45 SD2 HD1.
