HCS/SB 458 - This act modifies various provisions relating to healthcare professionals. PHYSICAL THERAPISTS The act adds physical therapists to the list of authorized health care practitioners who may sign statements necessary for a person to receive a windshield placard or special plates for a temporary or permanent physical disability (301.142). This provision is identical to provisions in HCS/SCS/SB 380 (2015), HCS/HB 720 (2015), SCS/HCS/HB 1002 (2015), HCS/SCS/SB 38 (2015), HCS/SCS/SB 146 (2015), HCS/SCS/SB 197 (2015), and HCS/SCS/SB 230 (2015), and substantially similar to provisions contained in CCS#2/HCS/SB 254 (2015). PRESCRIPTIVE AUTHORITY: HYDROCODONE This act allows certain advanced practice registered nurses, physician assistants, and assistant physicians to prescribe Schedule II - hydrocodone. Hydrocodone prescriptions are limited to a one five day supply without refill (195.070, 334.037, 334.104, 334.747). These provisions are similar to provisions contained in SCS/SB 313 (2015), HCS/HB 720 (2015), SCS/HCS/HB 709 (2015), HCS/SCS/SB 107 (2015), HCS/SS/SB 457 (2015), SCS/HCS/HB 422 (2015), and HCS/SCS/SB 38 (2015). PHYSICIAN LICENSURE The act provides that an applicant for licensure as a physician or a surgeon who does not achieve a passing score within three attempts on a licensing exam administered in one or more states may petition the State Board of Registration for the Healing Arts for an exception to such requirement based upon unusual or extenuating circumstances. Likewise, an applicant who does not pass a step of the United States Medical Licensing Examination within three attempts or does not pass all three steps within a seven year period may also petition the Board for an exception. The act states that applicants must provide proof of successful completion of the USMLE or an exam administered by the National Board of Osteopathic Medical Examiners, rather than just proof of completion (334.040). This provision is identical to provisions contained in SCS/HCS/HBs 671 & 683 (2015), and similar to provisions contained in HCS/SCS/SB 107 (2015), SB 411 (2015), and SS/SB 400 (2015). COLLABORATIVE PRACTICE The act states that when a physician reviews pursuant to a collaborative practice arrangement an advanced practice registered nurse's delivery of health care services, which includes chart review, the collaborating physician need not be present at the health care practitioner's site (334.104). Current law provides that an advanced practice registered nurse shall practice with the collaborating physician continuously present for one-month before practicing in a setting where the collaborating physician is not continuously present. This act states that this requirement does not apply to collaborative arrangements between a physician and an advanced practice registered nurse if the collaborative physician is new to a patient population to which the collaborating advanced practice registered nurse, assistant physician, or assistant physician is already familiar (334.104). These provisions are identical to provisions contained in HCS/SCS/SB 38 (2015), HCS/SCS/SB 107 (2015), and HSCS/SCS/SB 146 (2015), and similar to provisions contained in HCS/SS/SCS/SB 517 (2015)and HCS/SS/SB 416 (2015). MAINTENANCE OF PHYSICIAN LICENSURE The act provides that the state shall not require maintenance of licensure, as defined in the act, as a condition of physician licensure or any form of specialty medical board certification to practice medicine within the state. The State Board of Registration for the Healing Arts or any other state agency shall not discriminate against physicians who do not maintain specialty medical board certification (334.280). This provision is identical to provisions contained in SCS/HCS/HBs 671 & 683 (2015), HCS/SCS/SB 107 (2015), and SS/SB 400 (2014). INJUNCTION REQUESTED BY THE BOARD OF OPTOMETRY The act provides that the Board of Optometry may request a court to issue an order enjoining a person or entity from dispensing or selling contact lenses without a valid prescription from a licensed optometrist or physician (336.115) This provision is identical to HB 1167 (2015). EMERGENCY SUPPLY OF MEDICATION WITHOUT A PRESCRIPTION The act provides that only licensed pharmacists can make the determination to dispense an emergency supply of medication without the authorization form the prescriber (338.200). This provision is similar to provisions contained in HCS/SS/SB 457 (2015). PHARMACY LICENSE RENEWAL This act provides that the Board of Pharmacy shall not renew a nonresident pharmacy license if the applicant does not hold a current pharmacy license in the state in which the nonresident pharmacy is located (338.270). Additionally, the Board shall not renew an out-of-state wholesale drug distributor, out-of-state pharmacy distributor, or drug distributor license if the applicant does not hold a current license in the state in which the distribution facility is located. If the applicant is a drug distributor registrant then the entity must be authorized and in good standing with the Food and Drug Administration or within the state where the facility is located in order for the Board to renew the registration (338.347). These provisions are substantially similar to HB 199 (2015). MEDICATION SYNCHRONIZATION This act requires health carriers or managed care plans offering health benefit plans that provide prescription drug coverage to offer medication synchronization services that allows for the alignment of refill dates for an enrollee's prescription drugs that are covered benefits. The health carrier or managed care plan shall not charge an amount in excess of the otherwise applicable co-payment amount under the health benefit plan and shall provide a full dispensing fee to the pharmacy that dispenses the prescription drug so long as the terms of the medication synchronization services are met (376.379). This provision is identical to SB 528 (2015) and HCS/HB 198 (2015) and to provisions contained in HCS/SCS/SB 38 (2015) and similar to provisions contained in HCS/SS/SB 457 (2015). PHARMACY BENEFIT MANAGERS The act requires each contract between a pharmacy benefit manager (PBM) and a pharmacy or pharmacy's contracting representative to include sources utilized to determine maximum allowable cost and update such pricing information at least every seven days. A PBM shall maintain a procedure to eliminate products from the maximum allowable cost list of drugs (MAC list) or modify maximum allowable cost pricing within seven days if the drugs do not meet the standards as provided in the act. A PBM shall reimburse pharmacies for drugs subject to maximum allowable cost pricing based upon pricing information which has been updated within seven days. A drug shall not be placed on a MAC list unless there are at least two therapeutically equivalent multi-source generic drugs, or at least one generic drug available from only on manufacturer and is generally available for purchase from national or regional wholesalers. All contracts shall include a process to internally appeal, investigate, and resolve disputes regarding MAC pricing as provided in the act. Appeals shall be upheld if the pharmacy being reimbursed for the drug on the MAC list was not reimbursed according to the act or the drug does not meet the requirements for being placed on the MAC list (376.388). These provisions are similar to HB 780 (2015) and SB 325 (2015) and to provisions contained in HCS/SS/SB 457 (2015) and identical to provisions contained in HCS/SCS/SB 38 (2015) . JESSI BAKER HA 1 - THIS AMENDMENT REMOVES SECTION 336.115 RELATING TO INJUNCTION REQUESTS BY THE BOARD OF OPTOMETRY. THE AMENDMENT MODIFIES THE LANGUAGE IN SECTION 338.200 TO STATE THAT ANY REQUESTS FOR AN EMERGENCY SUPPLY OF MEDICATION DISPENSED BY A PHARMACIST SHALL BE DETERMINED BY A LICENSED PHARMACIST. THE AMENDMENT ALSO MODIFIES PROVISIONS RELATING TO MEDICATION SYNCHRONIZATION SERVICES, AND PROVISIONS RELATING TO CONTRACTS BETWEEN PHARMACY BENEFIT MANAGERS AND PHARMACIES.