24-718 Pharmacists Can Provide More Services to Members Under AB 317

Date: 07/11/24

New law expands the scope of practice and requires pharmacists to be paid under the member’s medical benefit

Effective January 1, 2024, Assembly Bill (AB) 317 allows pharmacists to bill for covered services that are within the pharmacist's scope of practice and follow certain conditions for member’s enrolled in Medi-Cal, Ambetter HMO, Ambetter PPO and Employer Group HMO/POS and PPO plans. Pharmacists must be reimbursed for these services under the member’s medical benefit.

This new law expands upon what AB 1114 did whereby the scope of services for pharmacists treating Medi-Cal members was expanded, as of January 1, 2017, and pharmacists must be reimbursed 85% of the Medi-Cal fee schedule for select services.

Billing and payment for pharmacist services

Health Net and its participating physician groups (PPGs) must pay pharmacists for services that are within their professional scope. This applies to pharmacist services delivered in both in-network pharmacies and, if the member has this covered in their pharmacy benefit, out-of-network pharmacies.

Pharmacists will only be reimbursed under the following conditions:

• Services performed are within the lawful scope of practice of the pharmacist.
• The member’s coverage provides reimbursement for identical services performed by other licensed health care providers.

PPGs are responsible for reimbursing duly licensed pharmacist delivered services under their Division of Financial Responsibility for the category of the service description.

Additional information

Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.

To access any of the assembly bills referenced in this communication, visit these URLs:

• AB 317 – Assembly Bill No. 317
• AB 1114 – Assembly Bill No. 1114

This information applies to Participating Physician Groups (PPGs).

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, including Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.