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F I S C A L I M P A C T R E P O R T

SPONSOR Sanchez, M.

ORIGINAL DATE

LAST UPDATED

2/24/07

HB

SHORT TITLE Pharmacists as Insurance Providers

SB 1097

ANALYST Wilson

ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT (dollars in thousands)

FY07

FY08

FY09 3 Year

Total Cost

Recurring

or Non-Rec

Fund

Affected

Total

$0.1

$0.1

$0.1 Recurring Various

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to HB577

SOURCES OF INFORMATION

LFC Files

Responses Received From

Health Policy Commission (HPC

Human Services Department (HSD)

Public Regulation Commission (PRC)

SUMMARY

Synopsis of Bill

Senate Bill 1097 amends definitions contained within the Insurance Code in the Health

Maintenance Organization Law and the Nonprofit Health Care Plan Law. The definition of

“basic health services" under the HMO law has been amended to include “services of pharmacist

and pharmacist clinicians" under medically necessary services. Definitions of pharmacist and

pharmacist clinicians are also added to the HMO law. The Nonprofit Health Care Plan law has

been amended to provide definitions for pharmacist and pharmacist clinicians.

FISCAL IMPLICATIONS

There is no direct fiscal impact; however adding the services of pharmacist and pharmacist may

increase claims costs and affect the premiums of the enrollees covered by the Risk Management

Division, the Retiree Health Care Authority and the New Mexico Public School Insurance

Authority. Any new required service may offer an enrollee more choices and a higher quality of

care, but has the potential to increase cost.

Senate Bill 1097– Page

2

SIGNIFICANT ISSUES

The PRC notes that pharmacist and pharmacist clinicians play an important role in the delivery

of health care services. SB 1097 recognizes this role and provides definitions for pharmacists and

pharmacist clinicians. Additionally, the bill includes basic health services provided by HMOs

must include medically necessary services provided by pharmacist and pharmacist clinicians.

HSD provided the following:

Pharmaceutical care, as used in the bill is not a commonly understood or defined term.

Since the addition of the term pharmaceutical care will require health maintenance

organizations and non-profit health care plans to pay for the service, the service needs to

be well defined.

There is a definition of pharmaceutical care in the Pharmacy Practice Act (which is not

the Act the bill is amending) but which if referenced in the bill could serve as the

definition:

Pharmaceutical care means the provision of drug therapy and other patient care services

related to drug therapy intended to achieve definite outcomes that improve a patient's

quality of life, including identifying potential and actual drug-related problems, resolving

actual drug-related problems and preventing potential drug-related problems.

This means HMOs and non-profit health plans that cover drug items will have to pay for

the “other patient services related to drug therapy intended to achieve definition outcomes

that improve a patient's quality of life, including identifying potential and actual drug-

related problems, resolving actual drug-related problems and preventing potential drug-

related problems" , as stated in the definition. It is not clear that an HMO or non-profit

health plan could take the position that their dispensing fee includes coverage of all these

additional services.

ADMINISTRATIVE IMPLICATIONS

The staff of the Department of Insurance of the PRC can handle the provisions of this bill as part

of their ongoing responsibilities.

RELATIONSHIP

SB 1097 relates to HB577 which also amends Section 59A-46-2 NMSA 1978 of the Health

Maintenance Organization Law to include the services of pharmacists and pharmacist clinicians

as part of insurance coverage.

OTHER SUBSTANTIVE ISSUES

The HPC provided the following:

Pharmacists and pharmacist clinicians provide services to New Mexico through

medication management, disease management and expanded practice including

Senate Bill 1097– Page

3

immunizations, tobacco cessation and emergency contraception.

According to the New Mexico Health Policy Commission’s 2005 Health Workforce

Profiles, in 2005, New Mexico had 1,450 Registered Pharmacists, 2,290 Pharmacy

Technicians and 79 Pharmacist Clinicians. Many individuals had more than one license

type; therefore, when duplicates were, there were 3,819 pharmacy professionals in New

Mexico. There were approximately 7.61 Registered Pharmacists per every 10,000 people

in New Mexico.

The New Mexico Pharmacists Association indicates that pharmacists are not recognized

as providers by insurance companies and other third party programs. In New Mexico,

pharmacists can prescribe based on protocols approved by the Board of Pharmacy, the

Medical Board and the Board of Nursing. The Centers for Disease Control and

Prevention recognize pharmacists as providers by inclusion in the requirement for a

National Provider Identification.

DW/nt