SENATE BILL REPORT

                            SB 5460

                    AS OF FEBRUARY 9, 1993

Brief Description:  Requiring recognition of pharmacist's cognitive services in medicaid fee setting.

SPONSORS: Senators Wojahn, West, Sheldon and Bauer

SENATE COMMITTEE ON HEALTH & HUMAN SERVICES

Staff:  Martin Lovinger (786‑7443)

Hearing Dates: February 19, 1993

BACKGROUND:

In reimbursing pharmacists for prescriptions delivered to Medicaid clients, Medicaid pays a discounted portion of the amount determined by the Department of Social and Health Services (DSHS) in its survey of the actual cost of pharmacy operations.  The discounted amount is usually cost-shifted to full paying customers. 

Cognitive services are those of judgment or education.  Cognitive services of pharmacists have never been considered in the fee formula.  It is felt by some that paying for cognitive services could result in lower overall prescription expenses under the Medicaid program.  Those savings would benefit taxpayers and other consumers of pharmaceutical services. 

SUMMARY:

The Medicaid program must establish a dollar value for cognitive services of pharmacists.  The Department of Social and Health Services (DSHS) may use an advisory committee to establish cognitive services fees.  Pharmacies will indicate what cognitive services have been delivered in billing Medicaid.  DSHS shall add the dollar value of the cognitive services to the prescription price to establish the total to be reimbursed.  DSHS may audit pharmacy records to verify the performance of cognitive services billed to Medicaid.  Discrepancies are subject to legal action for fraud.

Appropriation:  none

Revenue:  none

Fiscal Note:  requested February 3, 1993

Effective Date:  The bill contains an emergency clause and takes effect immediately.