Lawmaker concerned Medicaid omnibus allows pharmacists to practice medicine

[May 30, 2024]  By Catrina Petersen | The Center Square

(The Center Square) – A Medicaid omnibus bill passed the Illinois General Assembly on Saturday and some lawmakers say the legislature is prioritizing big pharma profits over the health of patients with a provision within the bill.

State Rep. Bill Hauter, R-Morton, a doctor, wasn’t on the floor Saturday night to vote "no" on Senate Bill 3268, but he later drew attention to a provision within the passed bill that allows pharmacists to test and treat patients for HIV, flu, strep throat and several other ailments.

“We’ve been stabbed in the back by national corporations and their associations that want to put their profits over patient safety. I don’t blame the pharmacists. Pharmacists are often overworked and unable to properly counsel patients on their medications that they are giving them. Pharmacists are starting to organize against their working conditions. They don't have the time or training to practice medicine, but ya know … profits over patients. Between dispensing medications, ringing up deodorant and Nerdz ropes [candy], they are going to practice medicine too?” Hauter asked.

In 2023, pharmacy employees at Walgreens stores across the United States staged walkouts over harsh working conditions.

Hauter said, in his professional experience, in RSV (a certain respiratory virus) diagnosis and treatment, the most important thing is a physical exam.

“I’ve seen children die from RSV. You listen to the kid’s lungs, accessory muscle breathing, you look at retractions, how fast they are breathing … we’re just going to test and treat a positive test [for RSV]? Let me guess every patient with a positive test for flu will get a very expensive prescription for Tamiflu,” said Hauter.

Under the proposed law, minors and someone with preexisting conditions could get tested and treated by a pharmacist. The bill stipulates that testing and treatment would be covered by the Illinois Medicaid Program for individuals enrolled. In total, the gross cost to taxpayers is $103.57 million for fiscal year 2025. State Rep. Robyn Gabel, D-Evanston, said pharmacists being able to test and treat individuals would address work shortages.

“Pharmacists should be able to practice at the top of their license and they are licensed to do this. Actually, there are 40 of these types of conditions they are allowed to test and treat, nationally, we are just asking [through] this bill for five of them. Pharmacists are trained in medications and interactions of medications and I think they will be able to do this job well,” said Gabel.

Illinois state Rep. Bill Hauter, R-Morton, during a virtual news conference - BlueRoomStream

Gabel said her bill will provide Medicaid reimbursement rate increases for low-income individuals seeking services from psychiatrists, dentists, dialysis providers and children’s health centers.

SB 3268 received bipartisan support. Republicans like Ryan Spain voted for the legislation despite concerns surrounding the pharmacist "test and treat" provision and in increased cost to taxpayers. Another Republican lawmaker is pointing out that under the proposed law, family caregivers of medically fragile children will receive Medicaid reimbursement.

During the debate on the bill, State Rep, Jed Davis, R-Newark, thanked the bill sponsor for adding a concern of his. Davis pointed to Article 170 of the bill which started out as his House Bill 4178 dealing with paid family caregivers.

“I want to mention a constituent of mine, Stephanie, and I want to go on record for her son, who is medically fragile. They came into my office and they were the reason for that bill [HB 4178], and now that bill is Article 170,” said Davis.

Davis’ original bill funded this program with money previously allocated to funding at-home caregiving through a contracted nurse or nurse’s aide. Instead, the money will go directly to the related adult who is already providing care. In order for the related caregiver to receive reimbursement, under Article 170 of the Medicaid omnibus, he or she must be a certified nursing assistant or aide. State Rep. Bob Morgan, D-Deerfield, supported the bill despite Republicans’ concern about allowing pharmacists to test and treat individuals with HIV, flu and strep throat.

“To my knowledge, in the time I have been here … we have never used a vehicle like this to take a scope of practice issue and put it into the Medicaid omnibus or the Budget Implementation Bill, I want to express my concern about that. Leader Gabel has expressed there is a commitment to work on this language. What I would ask of this body is to support this bill but also know the Healthcare Licenses committee will address this issue in the fall veto session and into the spring and we’ll look at whether or not there are things to scale back,” said Morgan.

Morgan said, personally, he didn’t think there would be anything wrong with pharmacists testing and treating the flu with Tamiflu, but that those debates should happen in the Healthcare Licenses committee. Morgan serves as chair on that committee.