UNOFFICIAL COPY 25 RS SJR 26/GA
Page 1 of 5
SJR002610.100 - 1291 - XXXX 2/14/2025 10:01 AM GA
A JOINT RESOLUTION directing the Department for Medicaid Services to 1
provide the Legislative Research Commission with a report regarding pharmacist 2
payment parity. 3
WHEREAS, the scope of practice for pharmacists is defined in KRS Chapter 315 4
and includes a number of clinical services such as testing and treatment for streptococcal 5
pharyngitis commonly known as strep throat, influenza, urinary tract infections, COVID-6
19, and sexually transmitted infections; and 7
WHEREAS, the scope of practice for pharmacists also includes providing patient 8
counseling on tobacco cessation, medication therapy management, chronic disease 9
management, and more services that pharmacists may provide independently or through 10
collaborative care agreements or protocols authorized by the Board of Pharmacy; and 11
WHEREAS, historically clinical services provided by pharmacists have not been 12
covered by most health plans; and 13
WHEREAS, during the 2021 Regular Session the Kentucky General Assembly 14
passed House Bill 48 which required private health insurance providers to cover clinical 15
services performed by pharmacists if those services are within their scope of practice and 16
to reimburse pharmacists for those services at a rate not less than that provided to other 17
nonphysician practitioners such as advanced practice registered nurses and physician 18
assistants; and 19
WHEREAS, House Bill 48 only applied to private insurance providers and not to 20
the Kentucky Medical Assistance Program, commonly known as Medicaid, or to the 21
Kentucky Children's Health Insurance Program (KCHIP); and 22
WHEREAS, as a result of the passage of House Bill 48 Kentucky's pharmacists can 23
now bill private insurance providers for clinical services but are not permitted to seek 24
reimbursement for the same services provided to individuals enrolled in Medicaid or 25
KCHIP; and 26
WHEREAS, as of November 2024, more than 1,400,000 Kentuckians, or nearly 27 UNOFFICIAL COPY 25 RS SJR 26/GA
Page 2 of 5
SJR002610.100 - 1291 - XXXX 2/14/2025 10:01 AM GA
one third of the state's population, are covered by Medicaid and KCHIP; and 1
WHEREAS, the percentage of Kentuckians covered by Medicaid and KCHIP is 2
significantly higher in many rural communities; and 3
WHEREAS, in many rural communities across the Commonwealth the closest and 4
most readily available healthcare provider is a local pharmacist; and 5
WHEREAS, the lack of coverage for clinical services provided by pharmacists 6
represents a significant barrier to care for many of the Commonwealth's most vulnerable 7
citizens; and 8
WHEREAS, when patients cannot readily access the care they need, their 9
conditions often worsen, resulting in visits to urgent care clinics and hospital emergency 10
rooms; and 11
WHEREAS, when clinical services are provided by physicians in urgent care or 12
emergency room settings, the cost to provide those services is significantly higher than if 13
the patient had been able to access those services at their community pharmacy; and 14
WHEREAS, an analysis of the fiscal impact of House Bill 48 in 2021 determined 15
that the cost of requiring insurance providers to cover clinical services performed by 16
pharmacists and to reimburse for those services at a rate not less than that paid to other 17
nonphysician providers was minimal and would increase premiums by between 0.00 18
percent and 0.03 percent; and 19
WHEREAS, the Kentucky General Assembly is committed to taking a data-driven 20
approach to policy making; and 21
WHEREAS, the Kentucky General Assembly does not currently have access to the 22
data necessary to determine the potential fiscal impact of requiring Medicaid and KCHIP 23
to comply with KRS 304.12-237, the statute created by House Bill 48; and 24
WHEREAS, the Department for Medicaid Services does have access to the data 25
necessary to determine the potential fiscal impact of such a policy; 26
NOW, THEREFORE, 27 UNOFFICIAL COPY 25 RS SJR 26/GA
Page 3 of 5
SJR002610.100 - 1291 - XXXX 2/14/2025 10:01 AM GA
Be it resolved by the General Assembly of the Commonwealth of Kentucky: 1
Section 1. The Department for Medicaid Services is hereby directed to prepare 2
and deliver a report on pharmacist payment parity to the Legislative Research 3
Commission for referral to the Interim Joint Committee on Appropriations and Revenue 4
and the Interim Joint Committee on Health Services no later than August 1, 2025. 5
Section 2. The pharmacist payment parity report shall, at a minimum, include 6
the following: 7
(1) A detailed summary of the changes that would be necessary if the Kentucky 8
Medicaid program, including any managed care organization with which the department 9
contracts for the delivery of Medicaid services, and the Kentucky Children's Health 10
Insurance Program (KCHIP) were required by future legislation to comply with KRS 11
304.12-237. The summary of changes shall include a review of: 12
(a) Administrative changes; 13
(b) Technology changes and updates; 14
(c) A comprehensive overview of the clinical services and the related Current 15
Procedural Terminology (CPT) codes for which pharmacists would be eligible to 16
bill if compliance with KRS 304.12-237 were required, the current reimbursement 17
rates for those services when provided by physician and nonphysician providers, 18
and the number of times those CPT codes were billed by physicians and 19
nonphysicians in 2023 and 2024; 20
(d) The need to onboard or credential pharmacists as providers of those services; 21
and 22
(e) The anticipated cost of all changes that would be necessitated by a 23
requirement to comply with KRS 304.12-237; 24
(2) An analysis of the anticipated effect a requirement to comply with KRS 25
304.12-237 would have on Medicaid and KCHIP claims and expenditures. The analysis 26
shall include as assessment of: 27 UNOFFICIAL COPY 25 RS SJR 26/GA
Page 4 of 5
SJR002610.100 - 1291 - XXXX 2/14/2025 10:01 AM GA
(a) The anticipated impact on the number of Medicaid and KCHIP claims filed on 1
behalf of Medicaid and KCHIP beneficiaries; 2
(b) The potential for offsetting claims to pharmacists or pharmacies from other 3
providers or care sites; and 4
(c) The anticipated impact on Medicaid and KCHIP expenditures on an annual 5
basis including fee-for-services claims payments, managed care capitation 6
payments, and any other potential fiscal impact that may result from a requirement 7
to comply with KRS 304.12-237; 8
(3) A review of the fiscal impact and overall cost of similar coverage and 9
reimbursement requirements observed in other states, if such data is available to the 10
department; 11
(4) A summary of the effect of KRS 304.12-237 on private insurance providers 12
including any increase in premiums charged to consumers and observed changes in 13
claims filed; 14
(5) An analysis of how a requirement to comply with KRS 304.12-237 might 15
impact access to care, health outcomes, and the overall health of Medicaid and KCHIP 16
beneficiaries. This analysis shall specifically address the impact on access to care, health 17
outcomes, and overall health of Medicaid and KCHIP beneficiaries in rural and 18
underserved communities; and 19
(6) A detailed timeline for implementing the changes necessary to comply with 20
KRS 304.12-237 including any necessary requests for approval or authorization from the 21
federal Centers for Medicare and Medicaid Services or any other federal agency. 22
Section 3. (1) If the Department for Medicaid Services determines that it 23
does not have access to the data necessary to fulfil the requirements of the pharmacist 24
payment parity report established in subsection (1)(c) or (4) of Section 2 of this 25
Resolution, the department shall request that information from the Department of 26
Insurance, and the Department of Insurance shall provide the Department for Medicaid 27 UNOFFICIAL COPY 25 RS SJR 26/GA
Page 5 of 5
SJR002610.100 - 1291 - XXXX 2/14/2025 10:01 AM GA
Services with any available data necessary to fulfil the reporting requirements established 1
in subsection (1)(c) or (4) of Section 2 of this Resolution. 2
(2) In fulfilling the reporting requirement established in subsection (3) of Section 3
2 of this Resolution, the Department for Medicaid Services shall contact the Medicaid 4
agencies in states that have implemented policies similar to KRS 304.12-237 in their 5
Medicaid program and request the information and data necessary to fulfil the reporting 6
requirement established in subsection (3) of Section 2 of this Resolution. 7