Michael Silber, Author at In The States

Arkansas

NACDS sent a support letter to Arkansas Commissioner of Insurance Alan McClain on Rule 128, the Pharmacy Benefits Manager Compensation Requirements for Network Adequacy, Fair and Reasonable Pharmacy Reimbursements. Without meaningful actions, like Emergency Rule 128 which protects patients by prohibiting health plans and PBMs administering benefits on behalf of a health plan from recouping or recovering any increased costs to dispense from a patient at the point of sale through increased co-insurance, co-payment, or deductibles, more dollars will continue to flow to PBMs instead of reducing Arkansans’ prescription drug costs and safeguarding access to their trusted and convenient pharmacies. The enforcement of Rule 128 by Commissioner McClain will protect vital access to lifesaving prescription drugs and pharmacy services for Arkansans across the state.

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

Michael Silber2024-11-14T10:49:30-05:00November 14, 2024|Arkansas|

California

The Department of Health Care Services posted the following alerts, weekly notice, and monthly bulletin on the Medi-Cal Rx Web Portal:

Also in California, Proposition 36, The Homelessness, Drug Addiction and Theft Reduction Act, passed resulting in various changes to criminal and drug laws, including increasing penalties for some offenses, and providing treatment programs for people with drug addictions. Proposition 36 increases punishment for some theft and drug crimes in three ways: 1) turns some misdemeanors into felonies; 2) lengthens some felony sentences; and 3) requires some felonies be served in prison.

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

Michael Silber2024-11-14T10:46:04-05:00November 14, 2024|California|

Colorado

State House Democrats elected their slate of leaders for the 2025 session, including re-electing House Speaker Julie McCluskie (D), who is entering her fourth and final term. The full House must ratify Rep. McCluskie’s nomination when it convenes on January 8, 2025.

Also in Colorado, Senate Republicans elected new leaders this week. State Sen. Paul Lundeen (R) remains as Minority Leader.

Finally in Colorado, Phase III of the Medicaid program Accountable Care Collaborative (ACC) is scheduled to begin July 1, 2025. The Department of Health Care Policy and Financing (HCPF) developed the program with stakeholder input to improve quality of care, close health disparities, improve care access, improve the member as well as provider experience and manage costs, which is critical to protecting member coverage, benefits and provider reimbursements, especially in tight state budget years.

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

Michael Silber2024-11-14T10:45:11-05:00November 14, 2024|Colorado|

Connecticut

On November 7, the Department of Consumer Protection finalized regulations on the Sale of Non-legend Drugs in Vending Machines.

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

Michael Silber2024-11-14T10:44:31-05:00November 14, 2024|Connecticut|

Indiana

The Health Coverage Programs (IHCP) posted provider Bulletin BT20244172, pharmacy provider updates approved by the Drug Utilization Review Board in October 2024.

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

Michael Silber2024-11-14T10:44:05-05:00November 14, 2024|Indiana|

Kansas

The Board of Pharmacy posted the November newsletter. It includes an update on the new Continuous Quality Improvement (CQI) regulations adopted earlier this year.

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

Michael Silber2024-11-14T10:43:31-05:00November 14, 2024|Kansas|

Kentucky

MedImpact announced that they identified Managed Care and Fee-for-Service claims adjudicated between August 23 and September 11, 2024, that were inadvertently paid at an inactive National Average Drug Acquisition Cost (NADAC) rate. Most of the rates utilized were lower than the active rate, but not all. The identified claims will be adjusted within 30 days to recalculate pricing to the NADAC pricing rates effective August 21, 2024, where appropriate. They will appear on your Remittance Advice (RA) or 835 to reflect the underpayment or overpayment. Impacted claims will not be recouped in totality; instead, they will only address the difference between the inactive and active NADAC rate.

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

Michael Silber2024-11-14T10:42:52-05:00November 14, 2024|Kentucky|

Louisiana

Legislators returned to Baton Rouge earlier this month for the third session this year to consider Gov. Jeff Landry’s (R) tax overhaul package.

Also in Louisiana, the Department of Health issued Informational Bulletin 24-42 updating the immunization fee schedules.

Also in Louisiana, the Board of Pharmacy continues to make progress on the proposed rule changes expanding the eligibility criteria for obtaining a pharmacy technician candidate registration by providing alternatives to a board-approved, nationally accredited pharmacy technician training program. The proposed rule changes remove the definition of Training Program and instead define Pharmacy Technician Educator, which includes a board-approved, nationally accredited training program, a Louisiana Department of Education program with a pharmacy technician career path and a Louisiana licensed pharmacist providing training in a permitted pharmacy. The Board submitted the second summary report to the Joint Legislative Oversight Committee on Health & Welfare.

Also in Louisiana, after the August public hearing on Automated Medication Systems (AMS), the Board submitted the second summary report to the Joint Legislative Oversight Committee on Health & Welfare.

Also in Louisiana, since five of the Board members’ terms expired on June 30, 2024, Gov. Jeff Landry (R) appointed Andy Soileau to replace Blake P. Pitre, who had served 42 years on the Board, and Butch Ray to replace Rock LeBas. The Governor also reappointed pharmacist Robert Cloud, Kevin LaGrange and consumer member Don Resweber.

Also in Louisiana, the Department of Health (LDH), in partnership with the Department of Public Safety and Corrections (DPSC), submitted an application to the Centers for Medicare and Medicaid Services (CMS) for an 1115 demonstration waiver to improve access to critical pre- and post-release services for Medicaid-eligible individuals who are incarcerated. This new waiver would allow Louisiana Medicaid to provide approved substance use treatment services, case management and a 30-day supply of all prescription medications to eligible individuals.

Finally in Louisiana, the Board of Pharmacy will meet on November 19-20, 2024; new officers and committee chairs will be chosen during this meeting.

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

Michael Silber2024-11-14T10:42:18-05:00November 14, 2024|Louisiana|

Maine

On September 16, MaineCare sent a message advising pharmacies that copays for pharmacy services would resume effective October 1, 2024, in conjunction with the end of the American Rescue Plan Act (ARPA). Follow up messages were also sent on September 27 and September 30.

Pursuant to MaineCare Benefits Manual Chapter 1 Section 1.09-1(B), no provider may deny services to a member for failure to pay a copayment.

As a reminder, effective October 1, 2024:

MaineCare reinstates copayments for Section 80: Pharmacy Services.
MaineCare no longer covers over-the-counter COVID-19 tests.
The federal government is supplying four free COVID-19 test kits.
The COVID-19 vaccine administration fee through the pharmacy benefit returns to $5.00.

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

Michael Silber2024-11-14T10:41:20-05:00November 14, 2024|Maine|

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