Nevada
The Board of Pharmacy posted the agenda for the two-day hybrid virtual/in-person October 13 and 14 meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) will delay the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans until April 1, 2023.
Tailored Plans, originally scheduled to launch December 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, Intellectual/Developmental Disabilities and traumatic brain injury.
The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations, which will operate the Tailored Plans, more time to contract with additional providers to support member choice and to validate that data systems are working appropriately. The decision is supported by the leadership of the state’s six LME/MCOs.
While the start of Tailored Plans will be delayed, specific new services will still go live December 1, 2022.
More information regarding the beneficiary choice period and other key dates leading up to the April 1, 2023, launch will be shared by NCDHHS in the coming weeks. For more information about Tailored Plans, please visit NC Medicaid’s Tailored Plan website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
As you are aware, Ohio Medicaid (ODM) implemented the Single PBM, Gainwell, at Midnight on October 1. NACDS has been working with members, ODM and Gainwell daily to provide solutions as they work through technical issues causing denials, many of which have since been resolved or temporarily patched over. To report any major system issues, please use the dedicated email that Gainwell/ODM is monitoring in real-time. If you need NACDS’ assistance to emphasize significant issues, please contact Jill McCormack.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
Gov. Tom Wolf (D) issued a news release this week announcing that the Naloxone Standing Order has been expanded to include the 2 Dose Formulation and encouraging patients to bring a copy of the standing order to pharmacies to request the drug. NACDS reminds members that the PA Naloxone Copay Assistance Program will reimburse pharmacies up to $75 for patient copays when the patient is hesitant to pick up the prescription due to cost. For practical operational reasons, the claim must be adjudicated on the current PACE Program system. However, a claim for ANY insured patient regardless of what type of insurance they have – commercial or public – qualifies. There are no criteria to proving financial hardship on the pharmacy because access is the point of the program.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
The Drug Utilization Review Board posted the agenda for October 21 meeting. Refer to the Texas Drug Utilization Review Board Handbook for the instructions about submitting written materials to the board before the meeting and public testifying on the day of the meeting.
Also in Texas, the Health and Human Services Commission (HHSC) updated the July 2022 Medicaid Preferred Drug List on September 28 and provided the following updates:
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Commission (PQAC) is conducting a survey to assess current pharmacy practices pertaining to accessible labeling for both patients with visual and/or print disabilities and patients who require that prescription information be translated into another language besides English. The survey also includes whether such options are already made available, and what technological, financial or resource-based obstacles prevent such options from being offered. Any licenses are strongly encouraged to participate in the survey.
Also in Washington, the fourth quarter Preferred Drug List (PDL) has been posted to the Reports webpage. This PDL is used by Uniform Medical Plan and the Department of Labor and Industry.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Medi-Cal posted the following:
- News: “Coming Soon: Novavax COVID-19 Vaccine Authorization” – The Department of Health Care Services is aggressively pursuing the necessary system and operational changes required to enable successful claims adjudication for administration of the Novavax COVID-19 vaccine. (August 3)
- News: “New Provider Financial Data Request Form Available” – Providers should use the Financial Data Request Form for questions regarding missing warrants, copies of Remittance Advice Details (RADs), accounts receivable transactions, and copies of 1099s. (August 3)
- News: “New Approval Messages for COVID-19 Uninsured Group User Guide” was posted to the Medi-Cal News – COVID-19 Uninsured Group (UIG) coverage will be updated with new approval messages for qualifying individuals. (July 29)
- Alert: “Temporary Problem for Real-Time Eligibility Transactions” – The Medi-Cal Program has been affected by a temporary problem that has affected all providers using CalPOS leased line connection for Real-Time eligibility transactions. (July 29)
Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal.
- Enteral Nutrition Updates to the List of Covered Enteral Nutrition Products, Effective September 1, 2022, and December 1, 2022 (August 1)
- Medi-Cal Rx Monthly Bulletin for August (August 1)
- Changes to Contract Drugs List (CDL) (August 1)
- Updates to the Medi-Cal Rx Provider Manual (August 1)
- Electronic Claims Agreement – Submission Deadline Extended (July 29)
- Medi-Cal Rx Weekly Wrap-Up for July 22-28 (July 29)
Finally in California, the Board of Pharmacy communicated the following:
- NEW Pharmacy Law Waiver: Prescriber Dispensing of Tecovirimat (TPOXX or ST-246) Oral Antiviral Medication to Emergency Room Patient (BPC sections 4068(a)(1), 4068(a)(5), 4068(a)(6), 4076.5 and 4427.2(a))
- Next Standard of Care Committee Meeting – August 25, 2022 (NEW DATE)
- Notice of Second Modified Text to amend sections 1793.5 and 1793.6 and to add section 1793.65 to Title 16 of the California Code of Regulations related to Pharmacy Technicians and Second Modified Text; written comments will be accepted until August 17, 2022.
- Effective January 1, 2023, Order of Adoption amending Division 17 of Title 16 of the California Code of Regulations, section 1715.65, related to Inventory Activities and Inventory Reconciliation Reports of Controlled Substances
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Iowa
The Board of Pharmacy published the following rulemaking.
- Adopted (effective August 31, 2022)
- ARC 6416C adopted and amends Chapter 3, “Pharmacy Technicians”, and Chapter 6, “General Pharmacy Practice” related to pharmacist delegation of technical functions.
- ARC 6417C adopted and amends Chapter 8, “Universal Practice Standards”, and Chapter 19, “Nonresident Pharmacy Practice”
- ARC 6418C adopted and amends Chapter 12, “Precursor Substances”
- Notice of Intended Action (Comments may be submitted until 4:30 p.m. on August 16, 2022.)
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- ARC 6421C amends Chapter 23, “Care Facility Pharmacy Practice”.
- ARC 6422C amends Chapter 41, “Outsourcing Facilities”.
- ARC 6423C amends Chapter 14, “Public Information and Inspection of Records”.
- ARC 6424C amends Chapter 12, “Precursor Substances”.
- ARC 6425C amends Chapter 10, “Controlled Substances”.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Massachusetts
The Massachusetts legislature completed, and Governor Charlie Baker (R) signed into law the state budget — HB (House Bill) 5500, which included several provisions of interest to pharmacies.
Mandatory Reporting by PBM (Pharmacy Benefit Manager) for State Agency Managed Care Contracts. The report must be filed with the Legislature by February 15, 2023, on the financial performance of the managed care and accountable care organizations, as well as their effectiveness in serving the MassHealth recipients.
Funding for Public Awareness Campaign Relative to Prescriptions for Contraceptives
Funding for Programs to Combat Opioid Addiction
Expanding Protection for Reproductive Rights – This law provides legal protections for Massachusetts health care providers, including pharmacists, from prosecution by out-of-state jurisdictions for legally protected health care and reproductive health care services and products, including contraceptives, provided in Massachusetts to out-of-state residents. This language protects these providers from criminal prosecution and associated civil lawsuits from states that prohibit access to legal health care and reproductive health services and products. This bill also provides for one statewide standing order to be issued to authorize the dispensing of emergency contraception by licensed pharmacists. This language would replace
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.