The Health and Human Services Commission announced that effective September 1, 2020, the Vendor Drug Program (VDP) will implement a uniform opioid policy across fee-for-service and managed care programs to encourage appropriate use and reduce opioid over-prescribing. The opioid policy does not apply to people receiving hospice care or palliative care, treatment for cancer, residents of a long-term care facility or another facility for which residents receive opioid substitution therapy for the treatment of opioid use disorder (OUD), or other people they elect to exempt based on an objective, confirmable physical pathology known to cause severe chronic pain not ameliorated by other therapies and for which opioid treatment is appropriate. According to the announcement, if diagnoses are not available in the medical data, exemptions will be handled on a case-by-case basis through the prior authorization process. More information can be found here.
Also in Texas. The Department of Insurance adopted an emergency rule that requires health benefit plans to extend established prior authorization approvals for drugs by 90 days and requires plans to authorize payment for a one-time additional 90-day supply of a covered drug. The rule also requires plans to cover prescription drugs from out-of-network pharmacies with no additional cost-sharing when the enrollee cannot obtain them in-network, requires plans to make alternative drugs available in the event of shortages, and prohibits plans from requiring an enrollee signature at the point of delivery. Also, the rule prohibits plans from refusing or reducing payment for a prescription drug based on the fact such a drug was delivered by a local pharmacy. The rule expires on September 27, 2020 (see page 2378 in the link: https://www.sos.state.tx.us/texreg/pdf/backview/0410/0410is.pdf).
Also in Texas. On August 8, Governor Greg Abbott extended his Disaster Declaration for all Texas counties in response to COVID-19 for another 30-days. Originally issued on March 13, 2020, the Disaster Declaration provides the state with a variety of resources to effectively serve Texans as the Lone Star State continues to mitigate the spread of COVID-19.
For more information, contact NACDS’ Mary Staples at 817-442-1155.