2007 California Welfare and Institutions Code Article 6.6. Hiv/aids Pharmacy Pilot Program

CA Codes (wic:14199-14199.3)

14199.  The department shall continue the pilot program established
on September 1, 2004, for the purpose of evaluating the provision of
medication therapy management services for people with HIV/AIDS. The
continuation of this program shall be effective July 1, 2008, for
services rendered on or after that date.


14199.1.  For purposes of this article, "medication therapy
management" means a distinct service or group of services that
optimize therapeutic outcomes for individual patients. Medication
therapy management services are independent of, but can occur in
conjunction with, the provision of a medication product.



14199.2.  (a) The pilot program provided for under this article
shall provide the necessary information to assess the effectiveness
of pharmacist care in improving health outcomes for HIV/AIDS
patients. If the department determines that the pilot program has
shown that HIV/AIDS-related medication therapy management service is
effective at improving the health outcomes of HIV/AIDS patients and
is cost effective, then the department may seek federal
authorization, through a state plan amendment or Medicaid waiver
application, to receive federal financial participation for this
service.
   (b) The department shall implement an HIV/AIDS-related medication
therapy management service pilot project in no more than 10
pharmacies.
   (c) The selection of the pharmacy providers shall be based on all
of the following:
   (1) Percentage of HIV/AIDS patients serviced by the pharmacy. More
than 90 percent of the total patients serviced by the pharmacy in
the months of May, June, and July 2004, must have been HIV/AIDS
patients.
   (2) Ability of the pharmacy to immediately provide specialized
services. The provider shall be required to establish specialized
services with capability to implement all statutorily mandated
services on the implementation date of the project. The pharmacy
shall provide all the services listed in subdivision (e).
   (3) All specialized services shall be rendered by a qualified
pharmacist or other health care provider operating within his or her
scope of practice. The department shall develop, in consultation with
pharmacy providers, the appropriate professional qualifications
needed by the pharmacists rendering services, including any
continuing education requirements.
   (d) The department shall select the first pharmacies that apply
and meet the criteria specified in subdivision (c) for the pilot
program.
   (e) Pharmacies that participate in this pilot program shall
provide the following services:
   (1) Patient-specific and individualized services provided directly
by a pharmacist to the patient, or in limited circumstances, the
patient's caregiver. These services are distinct from generalized
patient education and information activities already required by law
and provided for in the professional fee for dispensing.
   (2) Face-to-face interaction between the patient or caregiver and
the pharmacist during delivery of medication therapy management
services.  When barriers to face-to-face communication exist,
patients shall have equitable access to appropriate alternative
delivery methods.
   (3) Pharmacists and other qualified health care providers to
identify patients who should receive medication therapy management
services.
   (f) The department shall consult with the pilot program pharmacies
to establish appropriate outcome measures and the required
timeframes for reporting those measures, which in no case shall be
less than annually.  The department shall retain the ability to
require additional outcome measures during the course of the project.

   (g) The medication therapy management services shall be based on
the individual patient's needs and may include, but are not limited
to, the following:
   (1) Performing or obtaining necessary assessments of the patient's
health status.
   (2) Formulating a medication treatment plan.
   (3) Selecting, initiating, modifying, or administering medication
therapy.
   (4) Monitoring and evaluating the patient's response to therapy,
including safety and effectiveness.
   (5) Performing a comprehensive medication review to identify,
resolve, and prevent medication-related problems, including adverse
drug events.
   (6) Documenting the care delivered and communicating essential
information to the patient's other primary care providers.
   (7) Providing verbal education and training, beyond what is
already required by law, that is designed to enhance patient
understanding and appropriate use of the patient's medications.
   (8) Providing information, support services, and resources, such
as compliance packaging, designed to enhance patient adherence to his
or her therapeutic regimens.
   (9) Coordinating and integrating medication therapy management
services within the broader health care management services being
provided to the patient.
   (10) Home delivery of medications.
   (h) Participants in this pilot program shall be paid an additional
dispensing fee of nine dollars and fifty cents (.50) per
prescription for drug products added to or maintained on the Medi-Cal
List of Contract Drugs pursuant to Section 14105.43 for services
rendered on or after July 1, 2008.
   (i) Notwithstanding any other provision of law, the department
shall not make any payments for services listed in subdivision (g)
that were rendered during any time period in which subdivision (b) of
Section 14105.45 has been enjoined by a court order or is otherwise
not in effect.
   (j) Pilot project contracts under this section may be executed on
a noncompetitive bid basis and shall be exempt from the requirements
of Chapter 2 (commencing with Section 10290) of Part 2 of Division 2
of the Public Contract Code.
   (k) Pharmacies shall maintain a sufficient quantity of HIV/AIDS
medication in their inventories.
   (l) Pharmacies shall purchase HIV medications from state licensed
wholesalers.



14199.3.  This article shall become inoperative on July 1, 2009,
and, as of January 1, 2010, is repealed, unless a later enacted
statute that is enacted before January 1, 2010, deletes or extends
the dates on which it becomes inoperative and is repealed.