Erica Joyner – Page 8 – In The States

California

The Department of Health Care Services (DHCS) posted the following alerts and monthly bulleting on the Medi-Cal Rx Web Portal:

Diabetic Supplies: Updates to the Quantity and Fill Limitations for Diabetic Testing Supplies (October 5)
Updates to Enteral Nutrition Prescription Requirements (October 4)
90-Day Countdown: Medi-Cal Managed Care Plan Transition (October 3)
Respiratory Syncytial Virus (RSV) Vaccines Arexvy^TM and Abrysvo^TM Now on the Contract Drugs List (October 3)
How to Resolve Reject Code 76 – Plan Limitations Exceeded (October 2)
COVID-19 Antigen Over-the-Counter Test Coverage Updates, Effective November 1, 2023 (October 1)
Medical Supplies: Future Changes to Continuous Glucose Monitoring Systems Coverage Criteria and Prior Authorization Bundling (October 1)
Diabetic Supplies: Updates to the Dexcom G7® Continuous Glucose Monitoring Sensor Package Size Description, Effective October 1, 2023 (October 1)
Medi-Cal Rx Monthly Bulletin for October (October 1)
Changes to the Medi-Cal Rx Contract Drugs List (October 1)
Changes to Medi-Cal Rx Contract Drugs List – Authorized Drug Manufacturer Labeler Codes (October 1)
Changes to Medi-Cal Rx Pharmacy Reimbursable Physician Administered Drugs (October 1)
Updates to the Medi-Cal Rx Provider Manual (October 1)
Medi-Cal Rx Weekly Wrap-up for September 22-28 (September 29)
Reinstatement Spotlight (September 29)
Update: Reimbursement for New Commercial COVID-19 Vaccines (September 22).

Also in California, NACDS submitted a letter of support to Gov. Gavin Newsom (D) urging him to sign AB 1341. The governor subsequently signed AB 1341 (Chapter 276, Statutes of 2023) on September 30. The newly bill enacted permits pharmacists to provide COVID-19 medication as well as offer broader options of substance use disorder treatments as specified in the bill.

Also in California, NACDS submitted a letter to Gov. Gavin Newsom (D) urging him to veto AB 1286, legislation that would impose arbitrary staffing limits and impede pharmacies’ ability to optimize the use of pharmacy technicians to assist with technical duties that do not require a pharmacist’s professional judgement.

Finally in California, NACDS submitted a letter of support to Gov. Gavin Newsom (D) urging him to sign AB 317, legislation helping to support patient access to essential healthcare services provided by pharmacists by requiring healthcare service plans that cover care that is otherwise within pharmacists’ scope of practice to reimbursement pharmacy providers for delivering those services.

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

Erica Joyner2023-10-06T10:10:26-04:00October 6, 2023|California|

Connecticut

The Department of Consumer Protection urges pharmacists to continue to offer to prescribe naloxone for patients, when appropriate. This includes when filling prescriptions for:

Medications within the opioid class of drugs;
Patients with a history of opioid use disorder;
Family members and friends of individuals with a history of opioid use disorder and
Upon request by a patient.

As some insurance providers, including Medicaid, may continue to cover Narcan and ReVive, pharmacists should continue to submit claims when dispensing naloxone prescribed by a pharmacist or other authorized prescriber. Patients whose insurance providers do not cover these medications should contact their insurance provider for more information. Additional information can be found on the Drug Control Division website.

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

Erica Joyner2023-10-06T10:07:55-04:00October 6, 2023|Connecticut|

Florida

Gov. Ron DeSantis (R) and members of the Florida Cabinet approved rules to implement several provisions of the Prescription Drug Reform Act (SB 1550). The rules increase accountability among pharmaceutical middlemen known as pharmacy benefit managers (PBMs). As signed by the Governor earlier this year, SB 1550 institutes the most comprehensive reforms to Florida’s prescription drug market in state history. Additional information on the bill can be found here.

Also in Florida, the Agency for Health Care Administration (Agency), along with its fiscal agent, Gainwell Technologies, is introducing enhancements implemented as part of the new NPI initiative. A new Taxonomy Master List (TML) Tip Sheet, an updated Provider Master List (PML) Tip Sheet and an updated Pending Provider List (PPL) Tip Sheet is now available. The updated PML and PPL test examples are now available. The release of the updated PML and PPL changes will occur on October 26, 2023. After the release, a copy of the former version of the PML and PPL will remain archived on the Registration page of the Managed Care section of the Florida Medicaid Public Web Portal for reference. The release of the updated TML changes occurred on September 28, 2023. The release will replace the current version of the TML on the Florida Medicaid Public Web Portal. To access a copy of the new TML Tip Sheet and the updated PML and PPL Tip Sheets, please visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com, navigate to the Agency Initiatives tab, and select NPI Initiative.

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

Erica Joyner2023-10-06T10:06:20-04:00October 6, 2023|Florida|

Indiana

The Department of Health issued the standing order and protocol for pharmacists to provide without a prescription self-administered hormonal contraceptives products.

Statewide Standing Order for Administration of Hormonal Contraceptives (updated 9/1/23)
Appendix A
Appendix B
Appendix C
Appendix D
Statewide Protocol for Hormonal Contraceptives (updated 9/1/23)

Also in Indiana, the state’s Health Coverage Programs (IHCP) Medicaid issued several bulletins:

Pharmacy updates approved by Drug Utilization Review Board September 2023
IHCP updates Preferred Diabetes Supplies List
IHCP expands coverage for Vaxneuvance to the pediatric population
Correcting the ages covered through the VFC (Vaccines for Children) program for members ages 6 weeks through 18 years of age
IHCP updates pharmacy benefit long-acting reversible contraceptive coverage

IHCP removes cost-sharing obligations for pharmacist-administered adult vaccines

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

Erica Joyner2023-10-06T10:05:23-04:00October 6, 2023|Indiana|

Iowa

The Department of Health and Human Services, Iowa Medicaid posted INFORMATION LETTER NO. 2503-MC-FFS – 2023 Annual Provider Training.

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

Erica Joyner2023-10-06T10:04:34-04:00October 6, 2023|Iowa|

Kansas

The Board of Pharmacy announced that the Collaborative Drug Therapy Management Committee adopted several protocols for testing and initiation of therapy for:
– Suspected Influenza in Adult Patients
– Suspected Influenza in Patients under 18 years of age
– Suspected Acute Group A Streptococcal Pharyngitis in Adult Patients
– Suspected Acute Group A Streptococcal Pharyngitis in Patients under 18 years of age
– Suspected Acute Uncomplicated Lower Urinary Tract Infection in Women

Also in Kansas, the Board of Pharmacy approved a new emergency opioid antagonist (EOA) protocol adding an opioid antagonist drug ready-to-use nasal spray device to the drugs that may be dispensed.

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

Erica Joyner2023-10-06T10:03:50-04:00October 6, 2023|Kansas|

Kentucky

It is NACDS’ understanding that pharmacy claims for the updated Pfizer-BioNTech and Moderna COVID-19 vaccines have been rejecting under the pharmacy benefit through MedImpact. The Kentucky Pharmacy Association shared with us that Medicaid has decided to cover the new vaccines under the pharmacy benefit. MedImpact is working on system edits to accommodate pharmacy billing and will notify pharmacies when it is implemented. Additionally, managed care coverage will begin for the Abrysvo (Pfizer) and Arexvy (GSK) RSV vaccines effective October 6. For more information on Medicaid vaccine coverage, please see the updated version of MedImpact’s Vaccine Coverage Expansion.

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

Erica Joyner2023-10-06T10:03:05-04:00October 6, 2023|Kentucky|

Louisiana

Effective October 1, 2023, the Department of Health (LHD) is increasing the professional dispensing fee (PDF) $0.82 to $11.81 for local pharmacies only for all Medicaid Fee-for-Service (FFS) and Managed Care Organization (MCO)claims. The current PDF is $10.99.

Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing’s Interim Medicaid Executive Director Kimberly Sullivan announced the new implementation date for the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCOs) is now October 28, 2023. Magellan Medicaid Administration Inc. will serve as the single PBM processor for all six MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and United Healthcare).

Also in Louisiana, the Board published five final rules in the September 20, 2023, edition of the Louisiana Register, with immediate effective dates.

Regulatory Project 2023-03 – Pharmacy Benefit Managers
Regulatory Project 2023-04 – Healthcare Workplace Violence Prevention
Regulatory Project 2023-05 – Pharmacy Change of Ownership
Regulatory Project 2023-06 – Staffing Ratios
Regulatory Project 2023-08 – DATA-Waiver Registration Elimination

Finally in Louisiana, the Department of Health (LDH) Medicaid issued several documents detailing changes also effective October 1:

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

Erica Joyner2023-10-06T10:02:30-04:00October 6, 2023|Louisiana|

Maryland

Medicaid has issued Advisory #251 from the Office of Pharmacy Services in reference to the COVID-19 Home Test Kit Coverage for The Maryland Medicaid Fee-for-Service (FFS) Program. Anyone interested in directly receiving upcoming Advisories may forward his/her name, company affiliation and email address directly to: Deborah.washington@maryland.gov.

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

Erica Joyner2023-10-06T10:01:36-04:00October 6, 2023|Maryland|

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