California Health and Safety Code 1368.5 – (a) Every health care service plan that offers coverage for a …
(a) Every health care service plan that offers coverage for a service that is within the scope of practice of a duly licensed pharmacist shall pay or reimburse the cost of the service performed by a pharmacist at an in-network pharmacy or a pharmacist at an out-of-network pharmacy if the health care service plan has an out-of-network pharmacy benefit.
(b) Payment or reimbursement may be made pursuant to this section for a service performed by a duly licensed pharmacist only when all of the following conditions are met:
Terms Used In California Health and Safety Code 1368.5
- licensed: refers to , a license as a plan pursuant to Section 1353. See California Health and Safety Code 1345
- plan: refers to health care service plans and specialized health care service plans. See California Health and Safety Code 1345
- Provider: means any professional person, organization, health facility, or other person or institution licensed by the state to deliver or furnish health care services. See California Health and Safety Code 1345
(1) The service performed is within the lawful scope of practice of the pharmacist.
(2) The coverage otherwise provides reimbursement for identical services performed by other licensed health care providers.
(c) Nothing in this section shall require the plan to pay a claim to more than one provider for duplicate service or be interpreted to limit physician reimbursement.
(Amended by Stats. 2023, Ch. 322, Sec. 1. (AB 317) Effective January 1, 2024.)