SECTION 1. The general assembly hereby finds that:
(1) Timely access to testing and treatment for common, self-limiting, and communicable conditions is essential to protecting public health.
(2) Licensed pharmacists are among the most accessible health care professionals and are trained in medication therapy management, clinical assessment, and patient counseling.
(3) Expanding pharmacist authority to test for and treat certain conditions improves access to care, reduces unnecessary emergency department and urgent care utilization, and supports health system capacity.
(4) Pharmacist-provided test-and-treat services have been demonstrated to be safe, effective, and acceptable to patients when conducted pursuant to evidence-based protocols.
SECTION 2. Title 5 of the General Laws entitled "BUSINESSES AND PROFESSIONS" is hereby amended by adding thereto the following chapter: 5-19.4-1. Short title. This chapter shall be known and may be cited as the “Pharmacists Test-and-Treat Authority Act”. 5-19.4-2. Purpose. The purpose of this chapter is to authorize licensed pharmacists to independently test for and initiate treatment of certain conditions. 5-19.4-3. Definitions. As used in this chapter, the following terms shall have the following meanings:
(1) “Board” means the board of pharmacy established pursuant to §§ 5-19.1-3 through 5- 19.1-6.
(2) “CLIA-waived test” means a laboratory test categorized as waived under 42 CFR § 493.15
(3) “Department” means the department of health.
(4) “Pharmacist” means an individual licensed under chapter 19.1 of title 5 ("pharmacies").
(5) “Test-and-treat service” means the performance of a clinical assessment, the ordering or administration of a clinical laboratory improvement amendments (CLIA)-waived test, the interpretation of test results, and the initiation, modification, or discontinuation of drug therapy pursuant to a statewide protocol. 5-19.4-4. Authority to provide test-and-treat services.
(a) Notwithstanding any provision of law to the contrary, a pharmacist may independently provide test-and-treat services for conditions authorized by statewide protocol adopted by the board pursuant to §§ 5-19.4-5 and 5-19.4-10.
(b) A pharmacist acting pursuant to this chapter may:
(1) Order, perform, and interpret CLIA-waived tests;
(2) Initiate, dispense, administer, or prescribe medications; and
(3) Provide patient counseling, education, and referral as clinically indicated.
(c) A pharmacist shall not provide test-and-treat services for any condition not expressly authorized by statewide protocol. 5-19.4-5. Authorized conditions.
(a) The board, in consultation with the department, shall adopt statewide protocols authorizing pharmacist test-and-treat services for conditions including, but not limited to:
(1) Influenza;
(2) COVID-19;
(3) Group A streptococcal pharyngitis;
(4) Post exposure prophylaxis (PEP) for sexually transmitted infections for which CLIA- waived testing is available, unless testing is not readily available and delay in treatment may increase risk of infection; and
(5) Any additional condition determined by the board to be appropriate based on safety, evidence, and public health needs.
(b) In adopting or amending protocols, the board shall consider:
(1) Evidence-based clinical guidelines;
(2) Diagnostic reliability of available tests;
(3) Medication safety and appropriateness; and
(4) Referral criteria and exclusion conditions. 5-19.4-6. Training and competency.
(a) Prior to providing test-and-treat services, a pharmacist shall complete education requirements established by the board, which may include:
(1) Disease-specific education;
(2) Use and interpretation of CLIA-waived tests;
(3) Patient assessment and referral; and
(4) Documentation and reporting requirements.
(b) The board may require ongoing continuing education as a condition of continued authority for a pharmacist to provide test-and-treat services pursuant to the provisions of this chapter. 5-19.4-7. Documentation and communication.
(a) A pharmacist shall document each test-and-treat encounter in a patient record consistent with board rules and regulations adopted pursuant to § 5-19.4-10.
(b) Upon patient consent, the pharmacist shall make reasonable efforts to notify the patient’s primary care provider, if one exists, of the service provided within seven (7) business days.
(c) Pharmacists shall comply with all applicable public health reporting requirements. 5-19.4-8. Liability and standard of care.
(a) A pharmacist providing services pursuant to the provisions of this chapter shall be held to the standard of care applicable to pharmacists practicing within their scope of licensure.
(b) Nothing in this chapter shall be construed to create a higher standard of care or to expand civil liability beyond existing law. 5-19.4-9. Reimbursement.
(a) Test-and-treat services provided pursuant to this chapter shall constitute covered health care services for purposes of reimbursement under state-regulated health insurance plans and Medicaid, subject to applicable billing requirements.
(b) The office of the health insurance commissioner and the executive office of health and human services shall take actions necessary to implement this section. 5-19.4-10. Rulemaking authority. The board of pharmacy, in consultation with the department of health, shall promulgate rules and regulations necessary to implement and enforce the provisions of this chapter. The rules and regulations shall be promulgated no later than six (6) months after the effective date of this chapter. 5-19.4-11. Severability. If any provision of this chapter or its application is held invalid, the invalidity shall not affect other provisions or applications of the chapter that can be given effect without the invalid provision or application.
SECTION 3. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-96. Coverage for pharmacists’ services.
(a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2027, shall provide coverage for the services within the lawful scope of practice of pharmacists as defined in § 5-19.1-2 if the plan would have provided coverage if the service had been performed by a physician, advanced practice nurse, or physician assistant. No nonprofit medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that, no nonprofit medical service corporation may be required to pay for duplicative services actually rendered by both a pharmacist and any other healthcare provider.
(b) The health plan shall include an adequate number of pharmacists in its network of participating medical providers. The participation of pharmacies in the plan network’s drug benefit does not satisfy the requirement that plans include pharmacists in their networks of participating medical providers.
(c) The healthcare benefits outlined in this section shall apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this section outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.
SECTION 4. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Coverage for pharmacists’ services.
(a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2027, shall provide coverage for the services within the lawful scope of practice of pharmacists as defined in § 5-19.1-2 if the plan would have provided coverage if the service had been performed by a physician, advanced practice nurse, or physician assistant. No nonprofit medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that, no nonprofit medical service corporation may be required to pay for duplicative services actually rendered by both a pharmacist and any other healthcare provider.
(b) The health plan shall include an adequate number of pharmacists in its network of participating medical providers. The participation of pharmacies in the plan network’s drug benefit does not satisfy the requirement that plans include pharmacists in their networks of participating medical providers.
(c) The healthcare benefits outlined in this section shall apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this section outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.
SECTION 5. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following section: 27-20-84. Coverage for pharmacists’ services.
(a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2027, shall provide coverage for the services within the lawful scope of practice of pharmacists as defined in § 5-19.1-2 if the plan would have provided coverage if the service had been performed by a physician, advanced practice nurse, or physician assistant. No nonprofit medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that, no nonprofit medical service corporation may be required to pay for duplicative services actually rendered by both a pharmacist and any other healthcare provider.
(b) The health plan shall include an adequate number of pharmacists in its network of participating medical providers. The participation of pharmacies in the plan network’s drug benefit does not satisfy the requirement that plans include pharmacists in their networks of participating medical providers.
(c) The healthcare benefits outlined in this section shall apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this section outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.
SECTION 6. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following section: 27-41-101. Coverage for pharmacists’ services.
(a) Every group health insurance contract, or every group hospital or medical expense insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by any health insurance carrier, on or after January 1, 2027, shall provide coverage for the services within the lawful scope of practice of pharmacists as defined in § 5-19.1-2 if the plan would have provided coverage if the service had been performed by a physician, advanced practice nurse, or physician assistant. No nonprofit medical service corporation may require supervision, signature, or referral by any other healthcare provider as a condition of reimbursement to a pharmacist; provided that, no nonprofit medical service corporation may be required to pay for duplicative services actually rendered by both a pharmacist and any other healthcare provider.
(b) The health plan shall include an adequate number of pharmacists in its network of participating medical providers. The participation of pharmacies in the plan network’s drug benefit does not satisfy the requirement that plans include pharmacists in their networks of participating medical providers.
(c) The healthcare benefits outlined in this section shall apply only to services delivered within the health insurer’s provider network; provided that, all health insurers shall be required to provide coverage for those benefits mandated by this section outside of the health insurer’s provider network where it can be established that the required services are not available from a provider in the health insurer’s network.
SECTION 7. This act shall take effect on January 1, 2027.
