Revision: March 30, 2018, 11:53 a.m.
HB 1822-FN - AS AMENDED BY THE HOUSE
22Mar2018... 1118h
2018 SESSION
18-3030
01/04
HOUSE BILL 1822-FN
AN ACT making hormonal contraceptives available directly from pharmacists by means of a standing order.
SPONSORS: Rep. M. MacKay, Hills. 30; Rep. Knirk, Carr. 3; Rep. P. Schmidt, Straf. 19; Rep. J. MacKay, Merr. 14; Rep. Hinch, Hills. 21; Rep. LeBrun, Hills. 32; Rep. L. Ober, Hills. 37; Rep. W. Marsh, Carr. 8; Sen. Soucy, Dist 18; Sen. Reagan, Dist 17
COMMITTEE: Health, Human Services and Elderly Affairs
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ANALYSIS
This bill allows pharmacists to dispense hormonal contraceptives pursuant to a standing order entered into by health care providers.
This bill is the result of the commission established pursuant to 2017, 23.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
22Mar2018... 1118h 18-3030
01/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eighteen
AN ACT making hormonal contraceptives available directly from pharmacists by means of a standing order.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Pharmacies; Definitions. Amend RSA 318:1, VI-f to read as follows:
VI-f. "Hormonal contraceptives” means pills, patches, and rings which the United States Food and Drug Administration (FDA) classifies as available by prescription for the purpose of contraception or emergency contraception. It does not include similar items classified as “over the counter” by the FDA, intrauterine devices, shots, or intradermal implants.
VI-g. "Law enforcement officer'' means any officer of the state or political subdivision of the state who is empowered by law to conduct investigations of or to make arrests for offenses enumerated in this chapter.
2 New Section; Hormonal Contraceptives; Dispensing. Amend RSA 318 by inserting after section 47-k the following new section:
318:47-l Hormonal Contraceptives; Dispensing.
I. In this section, "standing order" means a written and signed protocol authored by one or more physicians licensed under RSA 329:12 or one or more advanced practice registered nurses licensed under RSA 326-B:18. Such agreement shall specify a protocol allowing the pharmacist licensed under RSA 318-B:18 to dispense hormonal contraceptives under the delegated prescriptive authority of the physician or APRN, specify a mechanism to document screening performed and the prescription in the patient's medical record, and include a plan for evaluating and treating adverse events. Any such prescription shall be regarded as being issued for a legitimate medical purpose in the usual course of professional practice.
II. Licensed pharmacists following standing orders may dispense hormonal contraceptives to persons in this state without a prior prescription.
III. A pharmacist, pharmacy, physician, or APRN issuing or following standing orders shall be prohibited from seeking personal financial benefit by participating in any incentive-based program or accepting any inducement that influences or encourages therapeutic or product changes or the ordering of tests or services.
IV. Prior to dispensing hormonal contraceptives under this section, a pharmacist shall complete an Accreditation Council for Pharmacy Education (ACPE) accredited educational training program related to hormonal contraceptives. In addition, pharmacists shall comply with the most current United States Medical Eligibility Criteria (USMEC) for Contraceptive Use as adopted by the Centers for Disease Control and Prevention.
V. The pharmacist shall provide each recipient of hormonal contraceptives pursuant to this section with a standardized information sheet written in plain language, which shall include, but is not limited to, the indication for the use of the hormonal contraceptive, the importance of follow-up care, and health care referral information.
VI. The board shall adopt rules, pursuant to RSA 541-A, relative to:
(a) Education and training required under paragraph IV.
(b) Content and format of the information sheet required under paragraph V, in consultation with the commissioner of the department of health and human services.
(c) A model statewide protocol, with the consent of the board of medicine, the board of nursing, and the department of health and human services to be used for the purposes of paragraph I.
(d) Other matters necessary to the proper administration of this section.
VII. The board of medicine shall not deny, revoke, suspend, or otherwise take disciplinary action against a physician based on a pharmacist's failure to follow standing orders provided the provisions of this section and the rules adopted under this section are satisfied. The board of nursing shall not deny, revoke, suspend, or otherwise take disciplinary action against an APRN based on a pharmacist's failure to follow standing orders provided the provisions of this section and the rules adopted under this section are satisfied. The board of pharmacy shall not deny, revoke, suspend, or otherwise take disciplinary action against a pharmacist who follows standing orders based on a defect in those standing orders provided the provisions of this section and the rules adopted under this section are satisfied.
3 New Paragraph; Pharmacists; Rulemaking. Amend RSA 318:5-a by inserting after paragraph XVIII the following new paragraph:
XIX. Dispensing hormonal contraceptives in accordance with RSA 318:47-l.
4 Insurance; Group; Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Amend RSA 415:18-i to read as follows:
415:18-i Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Each insurer that issues or renews any group policy of accident or health insurance providing benefits for medical or hospital expenses, which provides coverage for outpatient services shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for outpatient contraceptive services under the same terms and conditions as for other outpatient services. "Outpatient contraceptive services'' means consultations, examinations, and medical services, provided on an outpatient basis, including the initial screening provided through a pharmacy pursuant to RSA 318:47-l at a rate established by contract between the pharmacy and the insurer or its pharmacy benefits manager, and related to the use of contraceptive methods to prevent pregnancy which has been approved by the U.S. Food and Drug Administration. Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover all prescription contraceptive drugs and prescription contraceptive devices approved by the U.S. Food and Drug Administration under the same terms and conditions as other prescription drugs. Nothing in this section shall be construed as altering the terms and conditions of a contract relating to prescription drugs and outpatient services.
5 Insurance; Health Service Corporations; Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Amend RSA 420-A:17-c to read as follows:
420-A:17-c Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses, which provides coverage for outpatient services shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for outpatient contraceptive services under the same terms and conditions as for other outpatient services. "Outpatient contraceptive services'' means consultations, examinations, and medical services, provided on an outpatient basis, including the initial screening provided through a pharmacy pursuant to RSA 318:47-l at a rate established by contract between the pharmacy and the insurer or its pharmacy benefits manager, and related to the use of contraceptive methods to prevent pregnancy which has been approved by the U.S. Food and Drug Administration. Each health service corporation and every other similar corporation licensed under the laws of a different state that issues or renews any group policy of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover all prescription contraceptive drugs and prescription contraceptive devices approved by the U.S. Food and Drug Administration under the same terms and conditions as other prescription drugs. Nothing in this section shall be construed as altering the terms and conditions of a contract relating to prescription drugs and outpatient services.
6 Insurance; Health Maintenance Organizations; Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Amend RSA 420-B:8-gg to read as follows:
420-B:8-gg Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of group health insurance providing benefits for medical or hospital expenses, which provides coverage for outpatient services shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for outpatient contraceptive services under the same terms and conditions as for other outpatient services. "Outpatient contraceptive services'' means consultations, examinations, and medical services, provided on an outpatient basis, including the initial screening provided through a pharmacy pursuant to RSA 318:47-l at a rate established by contract between the pharmacy and the insurer or its pharmacy benefits manager, and related to the use of contraceptive methods to prevent pregnancy which has been approved by the U.S. Food and Drug Administration. Each health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any group health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover all prescription contraceptive drugs and prescription contraceptive devices approved by the U.S. Food and Drug Administration under the same terms and conditions as other prescription drugs. Nothing in this section shall be construed as altering the terms and conditions of a contract relating to prescription drugs and outpatient services.
7 New Section; Insurance; Individual; Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Amend RSA 415 by inserting after section 6-u the following new section:
415:6-v Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, which provides coverage for outpatient services shall provide to persons covered by such insurance who are residents of this state coverage for outpatient contraceptive services under the same terms and conditions as for other outpatient services. "Outpatient contraceptive services'' means consultations, examinations, and medical services, provided on an outpatient basis, including the initial screening provided through a pharmacy pursuant to RSA 318:47-l at a rate established by contract between the pharmacy and the insurer or its pharmacy benefits manager, and related to the use of contraceptive methods to prevent pregnancy which has been approved by the U.S. Food and Drug Administration. Each insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover all prescription contraceptive drugs and prescription contraceptive devices approved by the U.S. Food and Drug Administration under the same terms and conditions as other prescription drugs. Nothing in this section shall be construed as altering the terms and conditions of a contract relating to prescription drugs and outpatient services.
I. Sections 4-7 of this act shall take effect January 1, 2019.
II. The remainder of this act shall take effect 60 days after its passage.
18-3030
Amended 3/30/18
HB 1822-FN- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2018-1118h)
AN ACT making hormonal contraceptives available directly from pharmacists by means of a standing order.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2019 | FY 2020 | FY 2021 | FY 2022 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill allows pharmacists with a standing order authored by one or more licensed physicians or advanced practice registered nurses to dispense hormonal contraceptives without a prior prescription and with specific dispensing guidelines. The bill also adds initial screenings provided through a pharmacy at contracted rates to the definition of outpatient contraceptive services for health insurance prescription coverage.
The Office of Professional Licensure and Certification indicates the bill will create additional need for board and staff time to draft rules and will create more work for pharmacy inspectors. Additional staff will most likely be unnecessary, but such need is indeterminable at this time.
The Department of Administrative Services indicates the State Employee and Retiree Health Benefit Plan (HBP) is not subject to the requirements of the Insurance Department and/or the managed care law as a self-insured government plan. However, the HBP's third party benefits manager (PBM) will be subject to these requirements for its fully-insured clients, and therefore may be indirectly impacted by these changes.
The Insurance Department states the bill may result in the provision of services by lower cost providers, which may in turn lead to an increase in utilization. However, any impact on health insurance premiums, and any resulting impact on premium tax revenues is indeterminable.
AGENCIES CONTACTED:
Office of Professional Licensure and Certification, Department of Administrative Services, and Insurance Department