Erica Joyner – Page 9 – In The States

Michigan

The Board of Pharmacy has posted the public notice and agenda for the October 30 Rules Committee Work Group meeting and the minutes from the September 11 Rules Committee Work Group meeting.

Also in Michigan, MDHHS (Michigan Department of Health and Human Services) has proposed a rule regarding documenting patient consent for automatic refills that aligns with 2014 CMS guidance. Comments are due November 7 to the email noted on the policy’s transmittal sheet.

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

Erica Joyner2023-10-06T10:00:42-04:00October 6, 2023|Michigan|

Missouri

On September 28, the Board of Pharmacy issued a statement on working conditions recommending that pharmacies review current operations and address any issues that may impede safe patient care, including pharmacy staffing and any metrics/quotas that may hinder safe patient services. The Board also recommends pharmacies provide any additional resources or protections needed to minimize any job-related stressors of pharmacy personnel.

Also in Missouri, the Board of Pharmacy posted the September newsletter which includes detailed information on pharmacists’ new immunization authority, and the recently revised statewide naloxone standing order.

Also in Missouri, the state’s Department of Social Services Division of Health published rules in the State Register (p13-15) establishing a Pharmacy Federal Reimbursement Allowance and methodologies to determine the formula for the amount of allowance each pharmacy is required to pay for the privilege of providing outpatient prescription drugs.

Finally in Missouri, the Department of Health and Senior Services’ Division of Regulation and Licensure issued an emergency regulation on Controlled Substances.

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

Erica Joyner2023-10-06T09:59:48-04:00October 6, 2023|Missouri|

Ohio

The Senate Health Committee will hold a proponent hearing on SB 144, sponsored by Sen. Mark Romanchuk (R), on October 11 at 9:30 a.m. The legislation would authorize pharmacists and pharmacy technicians to administer routine childhood vaccines to patients 5 years of age and older and remove the prescription requirement for these vaccines. The Ohio Council of Retail Merchants and the Ohio Pharmacists Association will be testifying and NACDS will submit written testimony in support. Testimony and letters of support are due at 9:30 a.m. on October 10. If any members wish to weigh in, either in person or with written testimony, please contact Jill McCormack for further details.

Also in Ohio, the Board of Pharmacy has issued a lengthy agenda for the October 24 public hearing.

Finally in Ohio, the Board of Pharmacy has posted Proposed Compounding Rules related to USP 795 and 797. Comments are due October 24.

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

Erica Joyner2023-10-06T09:58:51-04:00October 6, 2023|Ohio|

Oklahoma

Gov. Kevin Stitt (R) convened a special session of the legislature on October 3 to address tax reforms.

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

Erica Joyner2023-10-06T09:57:56-04:00October 6, 2023|Oklahoma|

New York

Effective September 11, 2023, the State Department of Health’s NYRx, the Medicaid Pharmacy Fee-For-Service program, will provide reimbursement for qualified and enrolled pharmacies for COVID-19 vaccines and administration as approved by the FDA or authorized for emergency use. Billing codes and other guidance provided in the announcement.

Also in New York, on September 12, the State Education Department withdrew the proposed central fill pharmacy regulations. The Department and the Board of Pharmacy will convene stakeholders and restart the regulatory process. NACDS and members had been actively advocating for a change and delay in the proposed regulations, that amongst its provisions would have created a new central fill pharmacy registration class, prohibited central fill pharmacies from being open to the public, require that central fill pharmacies only prepare and fill prescriptions sent from an originating pharmacy, prohibited direct-to-patient central fill models and required the originating pharmacy to obtain consent from the patient in writing before a prescription may be prepared by a central fill pharmacy. A broad coalition of pharmacy interests are unified in opposition and pushed for support for delayed consideration. NACDS also previously submitted a letter during the public comment period.

Also in New York, on September 20, the State Department of Health held its monthly industry call for NYRx, the Medicaid fee-for-service program. The Education and Outreach team for NYRx holds virtual office hours on Tuesdays and Thursdays from 12:00 noon to 1:00 p.m. Eastern.

Finally in New York, on September 22, the State Department of Health, on behalf of NYRx, relayed to pharmacies that Medicaid patients are prohibited from paying out of pocket for covered services. The COVID vaccine is covered, and no Medicaid recipient should be asked to pay. The Department noticed that some Medicaid members were mistakenly informed that the vaccine was not covered and may have paid out of pocket. These claims should be promptly resubmitted, and the member contacted and reimbursed for all out-of-pocket costs. The State Department of Health has posted the “Medicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines.”

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

Erica Joyner2023-10-06T09:56:59-04:00October 6, 2023|New York|

South Carolina

Effective October 1, 2023, the Medicaid State Plan will be updated to allow South Carolina pharmacists to bill for hormonal contraception services in accordance with the Pharmacy Access Act and as described in this bulletin.

To be eligible for reimbursement for these services, pharmacists must complete a Healthy Connections Medicaid provider enrollment application. Pharmacists may apply on or after September 18, 2023. Interested pharmacists are encouraged to apply on the providers page of the Department of Health and Human Services’ (SCDHHS) website and enroll as an “individual pharmacist” under the provider type “other medical professional.” In addition to the standard enrollment information, pharmacists must provide information on the pharmacy or pharmacies where they will be providing this service. Training on completing this application and enrollment process is available on the SCDHHS website.

Once enrolled, pharmacies will be able to bill dates of service on or after October 1, 2023, for Medicaid members. This includes members enrolled in the full-benefit Medicaid program and those enrolled in the Family Planning limited benefit program. Pharmacies will be reimbursed for the procedure and diagnosis codes listed below under the Healthy Connections Medicaid member’s medical benefit utilizing the CMS form 1500. These services will be reimbursed in parity with nurse practitioners and physician assistants at 80% of physician rates. The reimbursement rates for these services are available in the Base Physician Fee Schedule available on SCDHHS website. Covered services and billing guidance will be added to the Physicians Services provider manual by October 1, 2023.

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

Erica Joyner2023-10-06T09:53:54-04:00October 6, 2023|South Carolina|

Tennessee

To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. The submitted claim should include a Diagnosis Code Qualifier (Field # 492-WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). If you have any questions, contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com

Also in Tennessee, TennCare held a webinar on the results of the recent Cost of Dispensing survey. During this event, TennCare disclosed the increased, updated professional dispensing fees (PDFs) applicable to all pharmacies within the TennCare Pharmacy network. Also, beginning November 1, 2023, pharmacies that have not responded to three or more TennCare surveys in the past will have their PDF set at $5.00. Based on the findings, the dispensing fees will be as follows:

Ambulatory

$13.16 for low-volume pharmacies (<65,000 prescriptions)
$9.02 for high-volume pharmacies (>65,000 prescriptions)

Specialty

$52.46 for non-blood factor medications
$172.69 for blood factor medications

Other

$13.16 for long-term care
$16.92 for 340B

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

Erica Joyner2023-10-06T09:53:01-04:00October 6, 2023|Tennessee|

Texas

Gov. Greg Abbott (R) issued a Proclamation convening a third special session on October 9 focused on public education funding, illegal immigration and private employer COVID vaccine mandates.

Also in Texas, the Health and Humans Services Commission’s (HHSC) September 2023 biannual specialty drug list is now available.

Also in Texas, the Legislature approved funding for the Board of Pharmacy (TSBP) to offer statewide integration of the Prescription Monitoring Program (PMP) in pharmacy management systems and NarxCare access at no cost to pharmacies beginning September 1, 2023.

Also in Texas, state Medicaid and Healthcare Partnership (TMHP) is gearing up to participate in a town hall meeting on the enrollment process for the Medicaid Vendor Drug Program (VDP), including Medicaid managed care. All pharmacy providers must enroll or complete their revalidation enrollment with HHSC through the Provider Enrollment and Management System (PEMS). Register here.

Also in Texas, after two weeks of the impeachment trial of Attorney General Ken Paxton (R), on September 16, the Senate voted to acquit the Attorney General on all 16 impeachment articles. A total of 21 senators would have had to approve at least one article of impeachment for Attorney General Paxton to be convicted and removed from office.

Also in Texas, HEB pharmacist Doug Read, R.Ph., PharmD. was reappointed to serve a three- year term on the Prescription Monitoring Program Advisory Committee, established under section 481.067 of the Texas Controlled Substances Act.

Also, the Board of Pharmacy (TSBP) adopted several new rules at its August meeting.

Also in Texas, on September 22, the TSBP convened a special hybrid meeting to review and approve the search committee’s recommendations for a new Executive Director/Secretary, replacing Tim Tucker who was terminated by the Board last February. By unanimous vote, Board members offered the job to Daniel (Danny) Carroll, a Pharm.D. graduate from The University of Texas at Austin College of Pharmacy who is currently the Director of Pharmacy at Northwest Hills Surgical Hospital in Austin. Carroll accepted and will begin in mid-October.

Finally in Texas, the Health and Human Services Commission (HHSC) published a report on the End of Continuous Medicaid Coverage September 2023 Monthly Enrollment Report to CMS.

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

Erica Joyner2023-10-06T09:52:00-04:00October 6, 2023|Texas|

Utah

The Department of Health & Human Services released the results of its recent survey of the average cost of dispensing a Medicaid prescription in the state. The mean cost of dispensing, weighted by Medicaid prescription volume, was $11.57 per prescription for all pharmacies including specialty pharmacies. For non-specialty pharmacies only, the mean cost of dispensing, weighted by Medicaid prescription volume, was $11.24 per prescription.

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

Erica Joyner2023-10-06T09:50:46-04:00October 6, 2023|Utah|

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