§153.3.1. Medicaid medication therapy management
A. The Legislature of Louisiana finds that:
(1)Medication choices are many, and the use of the wrong medication can cause
serious health complications and cost an estimated two hundred ninety billion dollars
annually in hospital admissions, extra doctor visits, lab tests, and nursing home admissions.
(2)The 2010 federal health reform legislation will require Medicaid to cover many
additional Louisiana citizens, greatly expanding the state Medicaid pharmacy program, the
number of expensive medications issued, and the potential for medication error.
(3)The Medicare Part D program has been successfully using medication therapy
management programs since the Medicare Modernization Act of 2003, and states such as
Mississippi, North Carolina, an
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§153.3.1. Medicaid medication therapy management
A. The Legislature of Louisiana finds that:
(1) Medication choices are many, and the use of the wrong medication can cause
serious health complications and cost an estimated two hundred ninety billion dollars
annually in hospital admissions, extra doctor visits, lab tests, and nursing home admissions.
(2) The 2010 federal health reform legislation will require Medicaid to cover many
additional Louisiana citizens, greatly expanding the state Medicaid pharmacy program, the
number of expensive medications issued, and the potential for medication error.
(3) The Medicare Part D program has been successfully using medication therapy
management programs since the Medicare Modernization Act of 2003, and states such as
Mississippi, North Carolina, and Florida have implemented similar programs in their
respective Medicaid programs.
(4) Peer-reviewed studies have demonstrated that medication therapy management
both improves patient health conditions and significantly reduces health costs.
B. For the purposes of this Section, the following terms shall have the following
meanings:
(1) "Medicaid medication therapy management" may include the review or
modification of medication therapy regimens of patients by a licensed pharmacist, in
collaboration with a primary health care provider, and may include the provision of the
following services to optimize the therapeutic outcomes of a patient's medication:
(a) Conducting a medication therapy review with the patient to identify, resolve, and
prevent medication-related problems, including adverse drug events.
(b) Working with the patient to develop a personal medication record that contains
all prescribed and nonprescription drugs, herbal products, and dietary supplements taken by
the patients.
(c) Working with the patient to develop a medication-related action plan for the
patient to use in collaborative medication self-management.
(d) Providing consultative services for the patient, intervening to address medication-related issues, and when the pharmacist believes it will be beneficial to the patient's health,
referring the patient to his regular health care provider for evaluation and additional referrals.
(e) Performing all necessary follow-up medication therapy management services for
the maintenance and support of the patient, as recommended by the primary health care
provider or specialist.
(f) Maintaining all necessary documentation, including the following and any other
records required for compliance with state and federal laws and regulations requiring
maintenance of patient records:
(i) Patient demographics and basic identifying information.
(ii) Pertinent patient-reported subjective information.
(iii) Objective observations regarding known allergies, diseases, conditions,
laboratory results, vital signs, diagnostic signs, physical examination results, and a review
of internal systems.
(iv) An assessment of medication-related problems.
(v) A care plan.
(vi) Any collaborative communications with the primary health care provider and
other health care professionals.
(vii) Patient-centric lists of actions to be followed to track progress is medication
self-management.
(viii) Any relevant transition plan or scheduling of follow-up visits.
(ix) Billing information including level of patient care, level of complexity, and
charges.
(2) "Medication therapy review" may include the following:
(a) Interviewing the patient to gather data, including demographic information,
general health and activity status, medical history, medication history, immunization history
and to collect the patient's personal assessment about his disease or condition and medication
use.
(b) In collaboration with a health care provider, performing necessary clinical
assessments of the patient's health status, including current or previous diseases or
conditions.
(c) Assessing patient values, preferences, quality of life, goals of therapy, cultural
issues, education level, language barriers, literacy level, and other characteristics affecting
the patient's communication skills that could affect patient outcomes.
(d) Assessing, identifying, prioritizing, and developing a plan for resolving
medication-related problems related to the clinical appropriateness of each medication, the
appropriateness of the dosage of each medication, including considerations of indications,
contraindications, and potential adverse effects, adherence to regimen, untreated diseases or
conditions, medication costs, and provider access considerations.
(e) Providing education and training on the appropriate use of medications and
monitoring devices.
(f) Coaching patients to manage their own medications.
(g) Evaluating the patient's ability to detect symptoms that could be attributed to
adverse reactions or interactions from medications.
(h) Interpreting, monitoring, and assessing a patient's laboratory results as ordered
by the health care provider.
(i) Monitoring and evaluating the patient's responses to his medication therapies,
including the safety and effectiveness of those therapies.
(j) Communicating appropriate information to the primary health care provider or
other health care professionals, including consultation on the selection of medications,
suggestions to address identified medication problems, updates on the patient's progress, and
recommended follow-up care.
C. The Louisiana Department of Health shall consider implementing a medication
therapy management program which may provide certain medication therapy management
services to qualified Medicaid recipients.
D. The department shall consider the following provisions when analyzing whether
to implement a Medicaid medication therapy management program:
(1) Eligibility of patients to receive medication therapy management services under
the program, using standards such as minimum number of medications, multiple chronic
medical conditions, and likelihood of incurring high drug costs.
(2) Requirements for pharmacists to receive reimbursement for medication therapy
management services, which may include at a minimum that:
(a) The pharmacist providing the services shall hold a valid and current license
issued by the Louisiana Board of Pharmacy.
(b) The pharmacist shall currently practice in a community pharmacy, ambulatory,
long-term, or home health care setting.
(c) The pharmacist shall develop a structured patient care process.
(d) The pharmacist shall maintain appropriate documentation that meets the
department's requirements for outcomes analysis and patient care.
(3) Amount of reimbursement to pharmacists for the provision of medication therapy
management services.
(4) Requirements for patient meeting criteria.
(5) Provisions for referrals and coordination with primary care providers.
(6) Limitations on the provision of medication therapy management services.
E. Nothing in this Section shall be construed to give pharmacists who are performing
medication therapy management services the authority to write prescriptions or change, alter,
or adjust prescription medication without the order of a physician, exercise independent
medical judgment, diagnose, request laboratory tests, provide patient care independently, or
otherwise engage in the practice of medicine.
F. The department may promulgate and publish rules and regulations pursuant to this
Section in accordance with the Administrative Procedure Act if the department elects to
implement a Medicaid medication therapy management program.