• Are pharmacists’ professional services covered by PRIVATE/COMMERCIAL insurance?

    An important aspect of whether individual pharmacists will participate in pharmacy-based buprenorphine induction and maintenance services is the extent to which the pharmacist will receive health insurance reimbursement for clinical services provided. Pharmacists are not universally recognized as healthcare providers eligible for reimbursement by Medicare Plan B (medical insurance not including prescription drug coverage), state Medicaid programs, or commercial insurance plans. While pharmacist “provider status” under Medicare is function of federal law, state laws and regulations can allow or require state Medicaid programs and commercial insurers to cover a limited or full range of pharmacist services. 

    LAPPA reviewed state laws/regulations governing Medicaid benefits and commercial insurance plans, as well as two recent surveys that proved very useful (see references below). Although the question focuses on coverage under state Medicaid programs, where state laws/regulations/policies address commercial insurance coverage requirements, the response notes this as well.

    References: 

  • Are pharmacists’ professional services covered by PRIVATE/COMMERCIAL insurance?

    • Fifteen states where pharmacists’ professional services are covered by commercial insurance plans; Alaska, California, Colorado, Delaware, Idaho, Kentucky, Maryland, Missouri, Nevada, Oregon, Tennessee, Texas, Washington, West Virginia, and Wisconsin

    • Seven states and Puerto Rico where no pharmacists’ clinical services appear to be covered under commercial plans;  Arizona, Connecticut, Florida, Georgia, Hawaii, Maine, Puerto Rico, and South Dakota.

    • 29 jurisdictions where commercial insurance may cover a limited set of pharmacist services - coverage will vary based on each insurance plan’s policies; Alabama, Arkansas, California, Illinois, Indiana, Iowa, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New York, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, and the District of Columbia.

    More details about each state can be found in the individual state charts.