Bill Text: CA SB1264 | 2017-2018 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medi-Cal: hypertension medication management services.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Engrossed - Dead) 2018-08-16 - August 16 hearing: Held in committee and under submission. [SB1264 Detail]

Download: California-2017-SB1264-Introduced.html

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CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill

No. 1264

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Introduced by Senator Stone

February 15, 2018

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An act relating to Medi-Cal.

LEGISLATIVE COUNSEL'S DIGEST

SB 1264, as introduced, Stone. Medi-Cal: hypertension medication management: pharmacists.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which qualified low-income persons receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes outpatient prescription drugs, subject to utilization controls and the Medi-Cal list of contract drugs.

The Pharmacy Law provides for the licensing and regulation of pharmacists by the California State Board of Pharmacy in the Department of Consumer Affairs. The law specifies the functions pharmacists are authorized to perform, including to administer, orally or topically, drugs and biologicals pursuant to a prescriber’s order, and to administer immunizations pursuant to a protocol with a prescriber. Existing law authorizes a pharmacist to administer drugs and biological products that have been ordered by a prescriber, and to perform other functions, including, among other things, to furnish self-administered hormonal contraceptives, nicotine replacement products, and prescription medications not requiring a diagnosis that are recommended for international travelers, as specified.

This bill would declare the intent of the Legislature to enact legislation to revise provisions related to the Medi-Cal program and advanced practice pharmacy in order to authorize pharmacists to provide hypertension management services to Medi-Cal beneficiaries.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NO   Local Program: NO  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 The Legislature finds and declares as follows:

(a) Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Hypertension is one of the major contributors to CVD and the greatest directly attributable risk for death worldwide. Hypertension poses a considerable burden on the health care system at the individual level and in terms of the cost burden of approximately $48.6 billion annually.

(b) The federal Centers for Disease Control and prevention (CDC) estimate that 32.6 percent of adults in the United States have hypertension, 54 percent of which cases controlled and 45 percent that are uncontrolled. From 1999 to 2014, the prevalence of hypertensive adults remained unchanged. While the percentage of controlled hypertensive adults improved from 31.5 percent in 1999 to 54 percent in 2014, there was no meaningful change in percentage of controlled individuals during that time period, suggesting that a different, innovative approach to blood pressure control is needed.

(c) With the November 2017 release by the American Heart Association of new guidelines for hypertension, the prevalence of hypertension, according to new definitions, has increased to 46 percent of adults—over 100 million with a blood pressure above 130/80 mmHg.

(d) The United States Preventive Services Task Force and the American Heart Association have conducted systematic reviews and meta-analyses of team-based care, and have concluded that engaging pharmacists in the management of hypertension is key to achieving goal for uncontrolled patients.

(e) In addition, pharmacist-driven hypertension management programs have proven to be cost effective. The Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) trial found that pharmacist-driven interventions produced statistically significant decreases in both systolic and diastolic blood pressure, at the low cost of $22.55 to increase hypertension control by one percentage point. The CAPTION trial also found that the intervention group had fewer physician visits, suggesting that a pharmacist-driven hypertension management program may allow primary care providers more time to focus on evaluating and diagnosing other complex health issues.

(f) The potential benefits of designating pharmacists as managers of hypertension medication therapy for Medi-Cal beneficiaries would include improved hypertension control and health status, and greater satisfaction with care for patients, as well as greater workplace satisfaction and better quality scores for providers. Additional benefits include lower costs and lower utilization of medical subspecialists.

(g) Current provisions authorizing advanced practice pharmacy do not authorize pharmacists to furnish or prescribe antihypertensive and related medications, or to have access to patient continuity of care documents, subject to applicable Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules.

(h) It is, therefore, the intent of the Legislature to enact legislation to revise provisions related to the Medi-Cal program and advanced practice pharmacy in order to authorize pharmacists to provide hypertension management services to Medi-Cal beneficiaries.