Kentucky Statutes 304.12-237 – Reimbursement for pharmacist services and procedures
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(1) As used in this section: (a) “Insurer”:
1. Means any insurer, self-insurer, self-insured plan, or self-insured group;
and
2. Shall include any health maintenance organization, provider-sponsored integrated health delivery network, or nonprofit hospital, medical- surgical, dental, and health service corporation; and
(b) “Practice of pharmacy” has the same meaning as in KRS § 315.010.
(2) To the extent permitted under federal law, for policies, plans, or contracts issued or renewed on or after June 29, 2021, an insurer, or a third-party administrator for such insurer, shall provide reimbursement to a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service or procedure:
(a) Is within the scope of the practice of pharmacy;
(b) Would otherwise be covered under the policy, plan, or contract if the service or procedure were provided by a:
1. Physician;
2. Advanced practice registered nurse; or
3. Physician assistant; and
(c) Is performed by the pharmacist in strict compliance with laws and administrative regulations related to the pharmacist’s license.
(3) This section shall not be construed to limit coverage provided under a policy, plan, or contract, or required under any other law.
Effective: June 29, 2021
History: Created 2021 Ky. Acts ch. 30, sec. 1, effective June 29, 2021.
1. Means any insurer, self-insurer, self-insured plan, or self-insured group;
Terms Used In Kentucky Statutes 304.12-237
- Contract: A legal written agreement that becomes binding when signed.
- Federal: refers to the United States. See Kentucky Statutes 446.010
and
2. Shall include any health maintenance organization, provider-sponsored integrated health delivery network, or nonprofit hospital, medical- surgical, dental, and health service corporation; and
(b) “Practice of pharmacy” has the same meaning as in KRS § 315.010.
(2) To the extent permitted under federal law, for policies, plans, or contracts issued or renewed on or after June 29, 2021, an insurer, or a third-party administrator for such insurer, shall provide reimbursement to a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service or procedure:
(a) Is within the scope of the practice of pharmacy;
(b) Would otherwise be covered under the policy, plan, or contract if the service or procedure were provided by a:
1. Physician;
2. Advanced practice registered nurse; or
3. Physician assistant; and
(c) Is performed by the pharmacist in strict compliance with laws and administrative regulations related to the pharmacist’s license.
(3) This section shall not be construed to limit coverage provided under a policy, plan, or contract, or required under any other law.
Effective: June 29, 2021
History: Created 2021 Ky. Acts ch. 30, sec. 1, effective June 29, 2021.