Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0685 Compare Versions

Only one version of the bill is available at this time.

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5	5	2025 -- S 0685
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7	7	LC001382
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2025
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO BUSINESSES AND PROFESSIONS -- PHARMACIES
16	16	Introduced By: Senators Valverde, Lauria, Murray, Thompson, Kallman, and Appollonio
17	17	Date Introduced: March 07, 2025
18	18	Referred To: Senate Health & Human Services
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21	21	It is enacted by the General Assembly as follows:
22	22	SECTION 1. Chapter 5-19.1 of the General Laws entitled "Pharmacies" is hereby amended 1
23	23	by adding thereto the following section: 2
24	24	5-19.1-37. Tobacco cessation therapy prescriptive authority. 3
25	25	(a) A pharmacist who is licensed pursuant to this chapter and who meets the requirements 4
26	26	of this section may prescribe and dispense FDA-approved tobacco cessation drug therapies to a 5
27	27	qualified patient pursuant to rules and regulations adopted by the board of pharmacy, subject to the 6
28	28	approval of the director of health in consultation with the director of behavioral healthcare, 7
29	29	developmental disabilities and hospitals. 8
30	30	(b) For the purposes of this section, "qualified patient" means a patient who: 9
31	31	(1) Is at least eighteen (18) years of age or of minimum age based on the most recent 10
32	32	guidance provided by the FDA; 11
33	33	(2) Is willing to participate in a structured tobacco cessation program consisting of an initial 12
34	34	evaluation and appropriate follow-up visits with the pharmacist prescribing tobacco cessation 13
35	35	products; and 14
36	36	(3) Has been educated on symptoms of nicotine toxicity, common and/or severe adverse 15
37	37	effects of prescribed medication(s), and when to seek medical treatment. 16
38	38	(c) Prior to prescribing tobacco cessation therapies, the pharmacist shall have completed 17
39	39	tobacco cessation education approved by the state board of pharmacy. 18
40	40	(d) The pharmacist shall refer or consult prior to prescribing regarding high-risk patients 19
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43	43	LC001382 - Page 2 of 6
44	44	or patients with an identified contraindication to FDA-approved tobacco cessation drug therapies 1
45	45	to the patient's primary care provider, as applicable, or to another provider, as appropriate. 2
46	46	(e) All pharmacists participating in prescribing therapy for tobacco cessation shall follow 3
47	47	the most updated guidelines and standards of care as approved by the board of pharmacy, subject 4
48	48	to the approval of the director of health in consultation with the director of behavioral healthcare, 5
49	49	developmental disabilities and hospitals. 6
50	50	(1) Pharmacists shall implement the most updated clinical practice guidelines to help 7
51	51	patients quit using all forms of tobacco. 8
52	52	(2) Pharmacists' services shall include an educational component to include counseling on 9
53	53	medication therapies and cessation strategies as well as referral to sources provided by the 10
54	54	department of health. 11
55	55	(f) Notification of the patient screening, the prescription record and the follow-up care plan 12
56	56	shall be provided to the patient's primary care provider, as applicable, within five (5) business days 13
57	57	following the prescribing of a tobacco cessation product. 14
58	58	(g) The definition of a qualified patient is subject to adaptation pursuant to rules and 15
59	59	regulations adopted by the board of pharmacy, subject to the approval of the director of health in 16
60	60	consultation with the director of behavioral healthcare, developmental disabilities and hospitals. 17
61	61	(h) Tobacco cessation drug therapies shall be covered by Medicaid upon approval of the 18
62	62	Medicaid section 1115 demonstration waiver to be submitted by the secretary of the executive 19
63	63	office of health and human services pursuant to chapter 12.4 of title 42. 20
64	64	SECTION 2. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 21
65	65	Policies" is hereby amended by adding thereto the following sections: 22
66	66	27-18-95. Mandatory coverage for tobacco cessation drug therapies. 23
67	67	Every group health insurance contract, or medical expense insurance policy, plan or group 24
68	68	policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or 25
69	69	after January 1, 2026, shall provide coverage for tobacco cessation drug therapy. 26
70	70	27-18-96. Coverage for pharmacists' services. 27
71	71	(a) Every group health insurance contract, or every group hospital or medical expense 28
72	72	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 29
73	73	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 30
74	74	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have 31
75	75	provided coverage if the service had been performed by a physician, advanced practice nurse, or 32
76	76	physician assistant. No nonprofit medical service corporation may require supervision, signature, 33
77	77	or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; 34
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81	81	provided that, no nonprofit medical service corporation may be required to pay for duplicative 1
82	82	services actually rendered by both a pharmacist and any other healthcare provider. 2
83	83	(b) The health plan shall include an adequate number of pharmacists in its network of 3
84	84	participating medical providers. The participation of pharmacies in the plan network's drug benefit 4
85	85	does not satisfy the requirement that plans include pharmacists in their networks of participating 5
86	86	medical providers. 6
87	87	(c) The healthcare benefits outlined in this section shall apply only to services delivered 7
88	88	within the health insurer's provider network; provided that, all health insurers shall be required to 8
89	89	provide coverage for those benefits mandated by this section outside of the health insurer's provider 9
90	90	network where it can be established that the required services are not available from a provider in 10
91	91	the health insurer's network. 11
92	92	SECTION 3. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 12
93	93	Corporations" is hereby amended by adding thereto the following sections: 13
94	94	27-19-87. Mandatory coverage for tobacco cessation drug therapies. 14
95	95	Every group health insurance contract, or medical expense insurance policy, plan or group 15
96	96	policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or 16
97	97	after January 1, 2026, shall provide coverage for tobacco cessation drug therapy. 17
98	98	27-19-88. Coverage for pharmacists' services. 18
99	99	(a) Every group health insurance contract, or every group hospital or medical expense 19
100	100	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 20
101	101	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 21
102	102	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have 22
103	103	provided coverage if the service had been performed by a physician, advanced practice nurse, or 23
104	104	physician assistant. No nonprofit medical service corporation may require supervision, signature, 24
105	105	or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; 25
106	106	provided that, no nonprofit medical service corporation may be required to pay for duplicative 26
107	107	services actually rendered by both a pharmacist and any other healthcare provider. 27
108	108	(b) The health plan shall include an adequate number of pharmacists in its network of 28
109	109	participating medical providers. The participation of pharmacies in the plan network's drug benefit 29
110	110	does not satisfy the requirement that plans include pharmacists in their networks of participating 30
111	111	medical providers. 31
112	112	(c) The healthcare benefits outlined in this section shall apply only to services delivered 32
113	113	within the health insurer's provider network; provided that, all health insurers shall be required to 33
114	114	provide coverage for those benefits mandated by this section outside of the health insurer's provider 34
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118	118	network where it can be established that the required services are not available from a provider in 1
119	119	the health insurer's network. 2
120	120	SECTION 4. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 3
121	121	Corporations" is hereby amended by adding thereto the following sections: 4
122	122	27-20-83. Mandatory coverage for tobacco cessation drug therapies. 5
123	123	Every group health insurance contract, or medical expense insurance policy, plan or group 6
124	124	policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or 7
125	125	after January 1, 2026, shall provide coverage for tobacco cessation drug therapy. 8
126	126	27-20-84. Coverage for pharmacists' services. 9
127	127	(a) Every group health insurance contract, or every group hospital or medical expense 10
128	128	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 11
129	129	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 12
130	130	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have 13
131	131	provided coverage if the service had been performed by a physician, advanced practice nurse, or 14
132	132	physician assistant. No nonprofit medical service corporation may require supervision, signature, 15
133	133	or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; 16
134	134	provided that, no nonprofit medical service corporation may be required to pay for duplicative 17
135	135	services actually rendered by both a pharmacist and any other healthcare provider. 18
136	136	(b) The health plan shall include an adequate number of pharmacists in its network of 19
137	137	participating medical providers. The participation of pharmacies in the plan network's drug benefit 20
138	138	does not satisfy the requirement that plans include pharmacists in their networks of participating 21
139	139	medical providers. 22
140	140	(c) The healthcare benefits outlined in this section shall apply only to services delivered 23
141	141	within the health insurer's provider network; provided that, all health insurers shall be required to 24
142	142	provide coverage for those benefits mandated by this section outside of the health insurer's provider 25
143	143	network where it can be established that the required services are not available from a provider in 26
144	144	the health insurer's network. 27
145	145	SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance 28
146	146	Organizations" is hereby amended by adding thereto the following sections: 29
147	147	27-41-100. Mandatory coverage for tobacco cessation drug therapies. 30
148	148	Every group health insurance contract, or medical expense insurance policy, plan or group 31
149	149	policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or 32
150	150	after January 1, 2026, shall provide coverage for tobacco cessation drug therapy. 33
151	151	27-41-101. Coverage for pharmacists' services. 34
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155	155	(a) Every group health insurance contract, or every group hospital or medical expense 1
156	156	insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 2
157	157	any health insurance carrier, on or after January 1, 2026, shall provide coverage for the services 3
158	158	within the lawful scope of practice of pharmacists pursuant to § 5-19.1-2 if the plan would have 4
159	159	provided coverage if the service had been performed by a physician, advanced practice nurse, or 5
160	160	physician assistant. No nonprofit medical service corporation may require supervision, signature, 6
161	161	or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; 7
162	162	provided that, no nonprofit medical service corporation may be required to pay for duplicative 8
163	163	services actually rendered by both a pharmacist and any other healthcare provider. 9
164	164	(b) The health plan shall include an adequate number of pharmacists in its network of 10
165	165	participating medical providers. The participation of pharmacies in the plan network's drug benefit 11
166	166	does not satisfy the requirement that plans include pharmacists in their networks of participating 12
167	167	medical providers. 13
168	168	(c) The healthcare benefits outlined in this section shall apply only to services delivered 14
169	169	within the health insurer's provider network; provided that, all health insurers shall be required to 15
170	170	provide coverage for those benefits mandated by this section outside of the health insurer's provider 16
171	171	network where it can be established that the required services are not available from a provider in 17
172	172	the health insurer's network. 18
173	173	SECTION 6. This act shall take effect upon passage. 19
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180	180	EXPLANATION
181	181	BY THE LEGISLATIVE COUNCIL
182	182	OF
183	183	A N A C T
184	184	RELATING TO BUSINESSES AND PROFESSIONS -- PHARMACIES
185	185	***
186	186	This act would add new sections which set forth conditions for pharmacists to prescribe 1
187	187	tobacco cessation drug therapies, including education approved by the state board of pharmacy. 2
188	188	The cessation therapies would be covered by all health insurance carriers on or after January 1, 3
189	189	2026. 4
190	190	This act would take effect upon passage. 5
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192	192	LC001382
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