Gov. Kathy Hochul (D) included in her budget an affirmation of the transition of Medicaid Fee-for-Service, which is set to become effective April 1. Another webinar will be held for stakeholders on February 21.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
ODM (Ohio Department of Medicaid) posted Myers & Stauffer’s 2022 Fee-For-Service Pharmacy Cost of Dispensing Survey report. NACDS is currently analyzing the report that found that the cost to dispense increased since 2020 but that increase was mostly prevalent among smaller pharmacies. Survey results included a weighted mean of $9.46 and a weighted median of $8.44 as the cost to dispense for non-specialty providers.
Also in Ohio, ODM Director Maureen Corcoran testified about the proposed biennial budget proposal, confirming that the proposal includes funding for a “modest” pharmacy Professional Dispensing Fee (PDF) increase. NACDS has been advocating for an increase since the September announcement of the PDFs for the SPBM (Single PBM). No details are yet available, but NACDS expects to update members very soon.
Finally, in Ohio, ODM and Gainwell (SPBM) are continuing to re-implement prior authorizations (PA) requirements in stages by specific drug classes. The reimplementation only applies to new, initial authorizations. Phase 3 begins on February 14 for these specific classes:
Members can reference the Unified Preferred Drug List on the SPBM portal to see products that require a PA. Additional PAs will be reimplemented during the first quarter of 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
SB 913, legislation allowing pharmacies administer medications to treat for certain conditions on the result of a positive screening test was heard in the Senate Health and Human Services Committee on February 9.
Also in Oklahoma, Insurance Commissioner Glen Mulready appointed Ashley Scott the new Director for the Oklahoma Insurance Department’s (OID) Pharmacy Benefit Manager (PBM) Compliance and Enforcement Division, and Molly Clinkscales as the lead attorney for the program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
NACDS submitted comments to the Board of Pharmacy expressing concerns with the current proposals in Divisions 019 and 041 related to safe pharmacy practice conditions. As currently drafted, these proposals give a pharmacist unrestricted authority to close a pharmacy if that pharmacist feels, in their opinion, that staffing is insufficient to fill prescriptions or provide other services to patients; this may result in pharmacy closures across the state. In our letter, we stated current regulations are sufficient to provide the Board with authority to act against pharmacies that are not providing a safe work environment.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The General Assembly’s joint Legislative Budget and Finance Committee (LBFC) finally released its study of Pharmaceutical Pricing in the Commonwealth’s Medicaid managed care program this week. The study was mandated by the passage of HB 941 of 2021, legislation that required key reforms to PBM practices in the program. These included prohibiting claw backs, increasing transparency and eliminating spread pricing. Though LBFC cited they had difficulty accessing key data from PBMs and the program, the report makes several recommendations to the General Assembly to tighten up current law, by increasing drug pricing transparency and enforcing the requirement for the release of data. NACDS is working with the Pennsylvania Association of Chain Drug Stores (PACDS), the Pennsylvania Pharmacists Association (PPA) and members to develop legislation to address these issues.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Please see the February 2023 provider update here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Effective for dates of service on or after March 1, the South Carolina Department of Health and Human Services (SCDHHS) will discontinue the hemophilia program arrangement with the South Carolina Department of Health and Environmental Control (SCDHEC). Factor services may be provided by any fee-for-service (FFS) enrolled pharmacy provider. Pharmacy reimbursement utilizes the standard basis of payment for the FFS pharmacy benefit at the lowest of:
Providers rendering care to Healthy Connections Medicaid members enrolled in FFS Medicaid should direct any questions related to this transition to the Magellan Medicaid Administration call center at (866) 254-1669. The call center is available 24 hours per day. For more information, click here.
Also in South Carolina, a stolen prescription pad alert has been issued. Please be very cognizant of any controlled substance prescriptions from Kraemer Women’s Care. Please call (803)-956-4018 to verify a prescription before filling.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee Justice Center will be hosting a webinar on March 1, at 11:00 am (Central) focused on how to prepare your team for having conversations with TennCare beneficiaries about their eligibility redetermination.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
House Speaker Dade Phelan (R) announced committee assignments this week.
Also in Texas, Sen. Pete Flores (R) filed SB 749, legislation making permanent the Public Readiness and Emergency Preparedness Act (PREP Act) authority that authorizes pharmacists to both order and administer routine immunizations for individuals three years of age and older. The House companion bill is HB 1105 by Rep. Four Price (R).
Also in Texas, Rep. Jacey Jetton (R) filed HB 2079, legislation would allow pharmacists to furnish medications for flu, strep and COVID as a result of a positive CLIA-waived test.
Also in Texas, NACDS is a sponsor of Texas Pharmacy Day at the Capitol on February 28. This is a great opportunity for pharmacists from all practice settings to show unity promoting our legislative agenda. Space is limited, so register now.
Finally in Texas, after a closed-door session at the quarterly meeting of the State Board of Pharmacy this week, the Board terminated the Executive Director Tim Tucker.
For more information, contact NACDS’ Mary Staples at 817-442-1155.