Bill
SB 1245
Requires insurers and plans to recognize pharmacists as participating providers and reimburse them for clinically appropriate services within their scope, expanding access.
Status and timeline
- Enacted as Act 220 (Gov. Msg. No. 1322). Signed by the Governor 05/27/2025; recorded as Act 220 on 06/25/2025. The act lists an overall effective date of 09/01/2025.
- The bill went through multiple committee and amendment stages (HHS, CPN, CPC, conference committee) and passed both chambers before enrollment and gubernatorial approval.
- Several bill drafts set specific implementation dates for insurance/policy changes (many sections refer to policies/contracts issued, amended, or renewed on or after July 1, 2026, or after December 31, 2025); see “Key provisions/timing” below.
Purpose and intent
SB 1245 requires private and public health plans in the State to recognize registered pharmacists as participating providers and to pay or reimburse pharmacists for clinically appropriate services they deliver within their licensed scope of practice. The goal stated in the bill is to expand access to care and use pharmacists’ clinical skills to help address statewide provider shortages and improve patient outcomes.
Key provisions and changes
- Recognize pharmacists as participating providers:
- Individual/group accident and health insurance (Chapter 431), hospital/medical service plans/mutual benefit societies (Chapter 432), and health maintenance organizations (Chapter 432D) must recognize licensed pharmacists (chapter 461) as participating providers.
- Coverage parity and reimbursement:
- Insurers, mutual benefit societies, and HMOs must include coverage for services provided by participating registered pharmacists “to the extent that the policy/plan provides coverage for the same service rendered by another health care provider.”
- Insurers/plans must pay or reimburse the pharmacist or pharmacy for services performed within the pharmacist’s scope.
- Medicaid and federally qualified health centers:
- The bill requires public health plans (Medicaid) to reimburse pharmacists for allowed services upon approval of the Hawaii Medicaid State Plan by CMS. It also explicitly includes pharmacists among practitioners whose services may be reimbursed under FQHC/rural health clinic prospective payment system rules.
- Credentialing and network participation (in later drafts/HD2):
- Clarifies that coverage limited to prescription drug benefits does not satisfy the requirement to include pharmacists in the network of participating providers.
- Prohibits denial of a pharmacist’s ability to contract when standard credentialing requirements are met; provides for recognition of credentialing when delegated to health care facilities.
- Telehealth and scope references:
- Several sections amend telehealth and provider definitions to explicitly include pharmacists among recognized “health care providers” where relevant.
Who is affected
- Pharmacists and pharmacies: gain formal recognition as participating providers and entitlement to reimbursement for covered services provided within scope.
- Insurers, HMOs, mutual benefit societies: must update provider networks, credentialing processes, coverage language, and claims/payment systems.
- Medicaid (State) program: required to pursue CMS approval where necessary to reimburse pharmacists.
- Patients/insureds: increased access to pharmacist-delivered clinical services, potentially improving access in medically underserved areas.
Potential impacts and considerations
- Access to care: May increase primary/medication-related services availability, especially in underserved areas.
- Cost and administrative effects: Insurers and plans will need to update networks, credentialing procedures, billing/coding, and reimbursement policies; could affect premium and utilization patterns.
- Implementation timing: Although the act is effective 09/01/2025, many provisions apply to policies/contracts issued, amended, or renewed on or after specified later dates (commonly July 1, 2026, in bill drafts). Check the enrolled/printed Act for the final effective dates for each section.
Related/companion measures
- HB 5398 is listed as a companion bill.
Note: The bill appeared in multiple draft forms (HD1, HD2, SD1/2, CD1) during the legislative process; the summary above reflects the core, final policy direction — recognition of pharmacists as participating providers and mandated reimbursement for covered services — as enacted in Act 220. For implementation details (exact effective dates by section, regulatory guidance, and CMS-related steps for Medicaid), consult the enrolled Act text and implementing agency notices.
Compiled from official sources — confirm details with the bill’s official record.
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