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So far Erica Joyner has created 377 blog entries.

Vermont

On October 5, the Department of Vermont Health Access (DVHA) updated the administration fee for the 2023-2024 commercial COVID-19 vaccines to $40.00, to align with Medicare reimbursement. This change is retroactive to September 11, 2023. DVHA-enrolled pharmacies may be reimbursed for injectable COVID-19 vaccinations administered to adults 19 years and older who are enrolled in Vermont’s Medicaid. Pharmacists must be enrolled with Vermont Medicaid, certified to administer vaccines in the State of Vermont and compliant with all Vermont laws governing vaccine administration. Failure to comply with all Vermont immunization regulations will subject these claims to recoupment. Participation in the Vermont Child Vaccine Program (VCVP) is mandatory for providers who wish to provide vaccinations to children under age 19 years insured by Vermont Medicaid.  If the pharmacy is not enrolled in VCVP please refer members through age 18 years presenting for vaccinations at pharmacies to their health care provider for State-supplied vaccines at no cost to the member.  Under the DVHA General Provider Agreement (Conditions 4.2), providers shall not bill a member for any covered service.

Also in Vermont, regarding currently covered COVID-19 vaccines:  Comirnaty® (Pfizer), Novavax®, Spikevax® (Moderna), pharmacies are reimbursed for the ingredient cost and administration fee for COVID-19 vaccines. No dispensing fee is paid for vaccine claims. Basis of Cost and Submission Clarification Codes are no longer required. Through the pharmacy POS system, the pharmacy must submit the code “MA” in the Professional Service Code field for the COVID-19 vaccine claim to document the administration of the vaccine and receive full reimbursement. There is no member copay for vaccines.

Required NCPDP Fields
NCPDP Field Number NCPDP Field Description Required Code
44Ø-E5 Professional Service Code MA
4Ø7-D7 Product/Service ID NDC for vaccine

For questions regarding this benefit, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.

Also in Vermont, the Board of Pharmacy held its regular meeting on September 27. The board accepted the state pharmacist prescribing protocols for emergency contraception (limited to medications, not IUDs) and the ACIP-recommended vaccines. Those two protocols will be posted on the state OPR (Office of Professional Regulation) website soon.

The Board clarified the language regarding Rule 10.26 in the Board’s 2014 “Policy on Hydrocodone Combination Products as Schedule II Drugs” that limits future fill prescriptions to two. The Board chose to remove the 2014 policy and follow the DEA (Drug Enforcement Administration) policy instead.

Additionally, the Board, in response to a request from the Department of Vermont Health Access to clarify blood pressure monitors qualifying as “accessory devices” and pharmacists prescribing authority as described in described in 26 V.S.A. § 2023(b)(3), decided that it is considered over the counter as defined in section 5 in regard to insurance coverage.

Finally in Vermont, on September 18, the Department of Vermont Health Access (DVHA) made changes to the Pharmacy Manual regarding automatic refills for Medicaid members. Vermont Medicaid does not pay for prescriptions that are not medically necessary or for individuals who are no longer eligible for Vermont Medicaid. Providers may not use automatic refill systems to deliver or provide prescriptions to members. Members and providers may not agree to waive the requirements of this section. Providers may contact members to initiate a refill, but members must choose to fill each prescription, and providers must determine that the member remains eligible for Vermont Medicaid before providers deliver or dispense the prescription. Providers may not assume that, because a member’s prescription authorizes refills, the member has implicitly requested that the provider refill the prescription. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2023-10-06T09:48:11-04:00October 6, 2023|Vermont|

Virginia

The Board of Pharmacy issued the following notice reminding pharmacy that the emergency rules on Workplace Conditions were effective September 29:

The Virginia Board of Pharmacy emergency regulations regarding pharmacy working conditions became effective today, September 29, 2023. All are strongly encouraged to read these important regulations addressing work environment requirements for pharmacy personnel that protect the health, safety, and welfare of patients. The regulations were adopted pursuant to HB 1324 introduced by Delegate Keith Hodges and passed by the 2022 General Assembly. The emergency regulations remain in effect until March 28, 2025. A public comment period will open on October 23, 2023, and remain open through November 22, 2023. Additional information regarding the status of the emergency regulations and public comment period may be found on Virginia Regulatory Town Hall. The Staffing Requests or Concerns Form referenced in the regulations will remain accessible on the Board’s website under Forms and Applications. Please review the requirements related to use of the form in the emergency regulations and listed at the top of the form.

Also in Virginia, the Department of Medicaid Services (DMAS) recently held a stakeholder call to discuss the implementation of SB 1538 of 2023, which requires pharmacy reimbursement for services. They are currently working on system changes to allow billing for the existing pharmacy testing and/or treatment protocols and our understanding is that they intend to further expand it to cover the protocols for flu, strep, COVID and UTI that were included in SB 948 of 2023 upon final approval of the rule. For more details, see the Enrolling Pharmacists as Providers slide deck.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

2023-10-06T09:45:23-04:00October 6, 2023|Virginia|

Washington

Six years of litigation challenging the state’s below cost dispensing fees resulted in a stunning settlement agreement with an unprecedented windfall for Washington State pharmacies. In exchange for dismissal of our state lawsuit challenging Washington State’s failure to adopt cost-based dispensing fees in April 2017 as required by federal law, the three pharmacy groups, NACDS, NCPA and the Washington State Pharmacy Association (WSPA) secured a commitment from Washington State to conduct its belated cost of dispensing study, the results of which are expected to update Washington State’s illegally inadequate dispensing fees ranging from $4.24-$5.25. Additionally, as a part of the settlement, the state will make over $60 million in retroactive payments to fee-for-service pharmacies that have been victim of Washington’s unlawfully low dispensing fees.

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) created a new rule, implementing the optional unexpired prescription drug donation program law.

Finally in Washington, in an effort to improve patient outcomes and better contain healthcare costs, the state Health Care Authority (HCA) is embracing Value Based Care (VBC) quality performance measures within the Medicaid managed care contracts. HCA is working with Comagine Health to conduct annual reviews of the current performance measures and their results. Beginning in 2024, HCA will move toward outcomes-based measures, rather than continuing to use process of care measures.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2023-10-06T09:44:29-04:00October 6, 2023|Washington|

California

The Department of Health Care Services (DHCS) posted these resources to provide further resources to assist with Medi-Cal Rx Reinstatement.

For further questions, email Medi-Cal Rx Education & Outreach. DHCS values your input. Please complete this short survey to provide feedback.

Also in California, this week, the Board of Pharmacy issued a notice to be “Beware of Scam Calls” as a result of licensees reporting being victimized by scam callers claiming to represent the “California State Board of Pharmacy” (Board) or another government agency.

Finally in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly wrap-ups on the Medi-Cal Rx Web Portal:

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2023-06-09T10:23:50-04:00June 9, 2023|California|

Florida

Consumers can purchase qualifying disaster preparedness supplies exempt from tax during the two 2023 Disaster Preparedness Sales Tax Holidays, May 27- June 9, 2023, and August 26-September 8, 2023.

Also in Florida, the Board of Pharmacy is developing amendments to Rule 64B16-27.650 regarding additional immunizations or vaccines which may be administered.

Finally in Florida, the Board of Pharmacy proposes amending Rule 64B16-28.108 regarding dispensing medication to a blind or visually impaired patient. More information can be found here.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2023-06-09T10:21:56-04:00June 9, 2023|Florida|

Illinois

Due to the access to care issue for bronchodilation medications for customers with asthma and other respiratory issues, the Department of Healthcare and Family Services (HFS) will temporarily remove the prior authorization requirements for generic albuterol sulfate inhalers, effective immediately. Pharmacy providers with questions may contact the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the applicable MCO.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2023-06-09T10:21:06-04:00June 9, 2023|Illinois|

Indiana

The Health Coverage Programs (IHCP), Medicaid, issued a bulletin updating the prior authorizations, preferred dug list and over-the-counter formularies approved at the May meeting of the Drug Utilization Review (DUR) Board.

Also in Indiana, IHCP announced pharmacy benefit COVID updates in response to the expiration of the public health emergency (PHE).

Also in Indiana, the Office of the Secretary of Family and Social Services (FFSA) recently adopted a rule clarifying electronic signatures.

Also in Indiana, last week Gainwell Technologies migrated the Indiana Medicaid system (CoreMMIS) to the Amazon Web Services (AWS) Cloud. IHPC’s Provider Healthcare Portal also migrated to AWS as part of this initiative.

Finally in Indiana, on July 5, 2023, the FFSA will adopt a single Medicaid formulary, called the statewide uniform preferred drug list (SUPDL), which will align members enrolled in Healthy Indiana Plan (HIP), Hoosier Care Connect or Hoosier Healthwise managed care entity (MCE) with the fee-for-service (FFS) formulary.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2023-06-09T10:20:22-04:00June 9, 2023|Indiana|

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