Pharmacy wins from this legislative session

Photo source: MPhA

Pharmacy advocates had a successful session at the Minnesota State Legislature this year, passing four of five Minnesota Pharmacy Alliance (MPA) priorities. Those priorities were passed through a massive omnibus bill (HF5247), which compiled provisions from the Tax Conference Committee and several other omnibus policy bills. It was approved and signed by Governor Tim Walz on May 24. 

“It's a huge win, I mean, this is the best legislative session we've had in years and years,” said Dr. Sarah Westberg, co-associate dean for clinical affairs and professor in the College of Pharmacy. “To get four priority bills passed is really big.”

Immunization and testing authorization for pharmacists, pharmacy technicians, and pharmacy interns 

Current Minnesota law states pharmacists can administer any FDA-approved vaccination to those 13 years of age or older, along with flu and COVID-19 vaccinations to those six and older. Under the PREP Act, the federal government gave emergency authorization during the COVID-19 pandemic for pharmacists to administer any vaccine to those three years of age and older. Though extensions occurred, those permissions were set to expire specifically for pharmacy technicians at the end of 2024. Under new state legislation (HF 1197/SF 1176), trained pharmacy technicians will keep that authority. Plus, new language allows pharmacists to deliver any vaccine to those six and up, along with COVID-19 and flu shots to those three and up. Pharmacists are able to order and administer immunizations and CLIA-waived tests, without the need for a protocol. 

Dr. Ann Philbrick, an associate professor at the College of Pharmacy and the University’s Department of Family Medicine and Community Health, testified for the new bill earlier this year to voice her concern for expiring permissions for technicians. 

“The big point that I was trying to make is that [technicians] have the education and they have the skill set… It would be going backwards because pharmacies have made workflow adjustments,” Philbrick said. “I think that over the past three years, the public has really gotten to expect vaccines from their pharmacy, so if we would have scaled that back, then we would have had an an issue where the the public would have wanted that and the pharmacies may not be able to keep up with demand because of workforce.”

Westberg said the legislation will also create greater opportunity for pharmacists to improve childhood vaccination rates, and that MPA plans to partner with the Minnesota Department of Health (MDH) to enroll more pharmacies in the federal Vaccines for Children program. 

Authorization for pharmacists to prescribe HIV prevention medications 

This legislation (HF 2466/SF 2320) will allow pharmacists to prescribe and administer preventative HIV medications PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), so long as they complete a specialized training on preventative HIV drugs. 

Westberg said this will not only allow pharmacists to help prevent individuals from contracting HIV, but reduce the barriers for at-risk individuals to access preventative care. 

“Some of the testimony at the hearings was from patients who said ‘I didn't even know this treatment was available and now I have HIV, so if I’d known it was available and I could have gotten it at my community pharmacy, I might have been able to prevent it,’” Westberg said. “There’s  lots of potential for public health and individual health impact with this legislation.”

However, she added that this legislation may take longer to implement, as the Board of Pharmacy will need to create a standardized protocol for it first. 

Increased Medicaid fee-for-service dispensing fee

This bill (HF 3902/SF 3971) will increase the Medicaid fee-for-service rate from $10.77 to $11.55 at local retail pharmacies in order to more accurately reflect the cost of dispensing medication. 

Representative Kristin Bahner, author of the House bill, said during a House Health Finance and Policy Committee meeting in April that the last fee increase occurred back in 2018, based on 2017 data collected from pharmacies on their dispensing costs, meaning that current rates are based on outdated information. She asserted that Medicaid is the largest insurer of Minnesotans and that the dispensing fee is “one of the only reimbursement rates that falls under the direct control of state government and plays a direct role in outpatient pharmacy reimbursement rate and ultimately their survival.” 

Pharmacy advocates pushed for this change to support independent and locally-owned pharmacies, as well as address rural pharmacy deserts. Westberg said passing this legislation is “really big,” though she stressed that this is only a “band-aid” for the current financial state of local pharmacies, not a long-term solution. 

Guaranteed coverage for pharmacist-provided health services

Under this legislation (HF 2503/SF 2459), a pharmacist-provided service that falls within their practice must be paid for by the health plan if it is covered by the plan when provided by a physician. 

“[Health plans] have to figure out how they're going to receive and respond to these claims from pharmacists as providers and pharmacist providers need to be clear about the services they're offering, how to define those services and then align their services with the appropriate billing codes and the services that meet the needs of their community,” Westberg said. 

This legislation is “probably the most complex in terms of implementation” out of the four priority bills that passed, due to the fact that health plans will have to figure out how to respond and broadly credential pharmacists, Westberg added. While some of the bill’s effects may occur right away, other aspects of it will likely take years to pan out.  

Persistence pays off

Westberg said the legislature truly recognized the role pharmacists play in their communities and the tough financial landscape for local pharmacies during this legislative session. She attributed the success to “persistence over time” and building stronger relationships with legislators, along with a closer working relationship with MDH and minimizing opposition from stakeholders. 

“We continued to be persistent and get support with multiple authors across both parties on all of our bills and I think that broader recognition that pharmacists are important,” Westberg said. “We had patients come help tell that story, certainly we had pharmacists telling that story, and it just became a common-sense solution to some of the challenges in today’s health care environment.”