SB324 would require private health insurance policies, hospital and medical service plans, and health maintenance organizations issued in Hawaii after December 31, 2025, to recognize licensed pharmacists as participating providers and cover pharmacist services when those services are within the pharmacist’s scope of practice and are otherwise covered if provided by another health care provider. The bill is aimed at expanding access to care in light of a statewide physician shortage and medically underserved areas in every county, with the legislature citing pharmacists’ role in medication management, diabetes education, and post-discharge support.
The measure also makes related changes to Medicaid and telehealth law. It would include pharmacists among the health care professionals whose services may be reimbursed under Medicaid prospective payment and fee schedule provisions, and it expands the statutory definition of “health care provider” for telehealth purposes to expressly include pharmacists. The Department of Human Services would be required to seek any necessary Medicaid state plan amendment or waiver from the federal government, and the Medicaid-related provisions would not take effect until federal approval is obtained.
Impact
If enacted, SB324 would amend chapters 431, 432, and 346 of the Hawaii Revised Statutes to create explicit reimbursement and coverage obligations for pharmacist-delivered services across commercial insurance, mutual benefit society plans, Medicaid payment rules, and telehealth definitions. It would not require coverage for services outside a pharmacist’s lawful scope, but it would require parity where the same service is already covered when delivered by another provider. The bill would also trigger administrative action by the Department of Human Services to pursue federal Medicaid approval before certain sections become operative.
Sentiment
The bill’s stated purpose and framing are strongly supportive of pharmacists as a way to address provider shortages and improve access to care, and the bill description reflects a pro-expansion, pro-reimbursement approach. However, the available legislative history shows limited advancement: the Senate HHS committee deferred the measure on February 10, 2025, and there are no recorded votes or transcript excerpts indicating broader support or opposition. Overall, the sentiment in the available record is favorable in concept but procedurally unresolved.
Contention
The main policy issue is whether insurers and public health programs should be required to reimburse pharmacists directly for services that overlap with other licensed providers’ services. Potential concerns include cost to insurers and Medicaid, the scope of pharmacist practice, and whether coverage should be limited to contracted or “participating” pharmacists. Another point of complexity is federal approval: the Medicaid-related provisions depend on a state plan amendment or waiver, which could delay or limit implementation. The committee deferral suggests these questions may have remained unsettled at the time of the bill’s first hearing.
Relating to the regulation of pharmacists and the practice of pharmacy, including the administration of a medication and the ordering and administration of an immunization or vaccination by a pharmacist.
Regulation of pharmacy benefit managers, fiduciary and disclosure requirements on pharmacy benefit managers, and application of prescription drug payments to health insurance cost-sharing requirements. (FE)