CA AB 1366
deadReimbursement for pharmacist services.
California · 2025-2026 Regular Session · lower
Description
Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to low-income individuals pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under existing law, pharmacist services are a benefit under the Medi-Cal program, subject to federal approval, and the rate of reimbursement for pharmacist services is 85% of the fee schedule for physician services, except for medication therapy management (MTM) pharmacist services. Existing law requires the department to implement an MTM reimbursement methodology relating to the dispensing of qualified specialty drugs by an eligible contracting pharmacy, which would be intended to supplement Medi-Cal payments to eligible pharmacies for MTM pharmacist services provided in conjunction with certain specialty drug therapy categories. This bill would additionally require the rate of reimbursement for advanced practice pharmacist services to be the same as the fee schedule for physician services, including MTM pharmacist services. The bill would require the department to implement an MTM reimbursement methodology relating to the use of drugs to ensure that Medi-Cal payments are only made to eligible advanced practice pharmacists or pharmacies for MTM pharmacist services provided in conjunction with certain specialty drug therapy categories. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or disability insurer that offers coverage for pharmacist services to 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 insurer has an out-of-network pharmacy benefit. Existing law authorizes this payment or reimbursement when specified conditions are met, including that the coverage otherwise provides reimbursement for identical services performed by other licensed health care providers. This bill would additionally require those health care service plans and disability insurers to pay or reimburse the cost of the service performed by an advanced practice pharmacist enrolled as a provider with the plan or insurer. The bill would authorize payment or reimbursement if the coverage otherwise provides reimbursement for similar services performed by other licensed health care providers, among other requirements. Because a willful violation of the bill's requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
- Introduced
- 2025-02-21
- Status date
- —
- Latest action
- 2026-02-02 — From committee: Filed with the Chief Clerk pursuant to Joint Rule 56.
- Bill type
- bill
- Last updated
- —
Subjects
Sponsors
- Floraauthor
Committees
Not provided by source.
Action timeline
2025-02-21
Introduced. To print.
introduction
2025-02-22
From printer. May be heard in committee March 24.
2025-02-24
Read first time.
reading-1
2025-03-28
Referred to Com. on HEALTH.
referral-committee
2025-03-28
From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
amendment-introduction,amendment-passage,committee-passage,reading-1,reading-2,referral-committee
2025-04-01
Re-referred to Com. on HEALTH.
referral-committee
2026-01-05
From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
amendment-introduction,amendment-passage,committee-passage,reading-1,reading-2,referral-committee
2026-01-06
Re-referred to Com. on HEALTH.
referral-committee
2026-01-13
From committee: Do pass and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 15. Noes 0.) (January 13). Re-referred to Com. on APPR.
committee-passage,committee-passage-favorable,referral-committee
2026-01-22
In committee: Set, first hearing. Referred to suspense file.
referral-committee
2026-01-22
In committee: Held under submission.
2026-01-31
Died pursuant to Art. IV, Sec. 10(c) of the Constitution.
failure
2026-02-02
From committee: Filed with the Chief Clerk pursuant to Joint Rule 56.
committee-passage,failure
Versions
Documents
Votes
Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar
2026-01-13 · pass · 15-0
Member-level votes (16)
- Bonta: yes
- Mark González: yes
- Patel: yes
- Aguiar-Curry: yes
- Schiavo: yes
- Gallagher: yes
- Krell: yes
- Stefani: yes
- Addis: yes
- Sanchez: yes
- Sharp-Collins: yes
- Patterson: yes
- Carrillo: yes
- Chen: yes
- Caloza: yes
- Celeste Rodriguez: other
Related bills
No related bills recorded for this bill.
Official source
Attribution
Data from openstates_bulk_csv, retrieved 2026-07-24T01:34:27.960412Z
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