Medicaid could pay qualified clinical pharmacists to manage medicines for children with complex needs

Medicaid could cover medicine management by qualified clinical pharmacists for children with complex medical needs. The coverage provision concerns Medicaid-eligible children with complex medical needs. Pharmacists would review medicines and supplements, make personal medicine plans, check how children use them, and follow up. Pharmacists would have to meet education, training, and credential rules set by the state Medicaid office and pharmacy board. The Human Services Commissioner would seek any federal approval needed to put the Medicaid provision in place. If enacted, this provision would take effect on the first day of the sixth month after enactment.

Qualified clinical pharmacists would not need a written doctor agreement to provide this Medicaid service. The qualification rules concern children with complex medical needs in NJ FamilyCare, which includes Medicaid and the Children’s Health Insurance Program. The doctor-agreement exception concerns the bill’s Medicaid service. The state Medicaid office and pharmacy board would set the education, training, and credential rules pharmacists must meet. Rules for pharmacists and doctors managing drug treatment together would not apply to this care. If enacted, these rules would take effect on the first day of the sixth month after enactment.

The state Medicaid office would sign payment contracts with clinical pharmacists and review the results of their care. The contracts and reviews concern medicine management for Medicaid-eligible children with complex medical needs. The contracts would use an approach that considers the value of care. The office would check results and whether the services fit its payment goals. If enacted, these requirements would take effect on the first day of the sixth month after enactment.