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So far Michael Silber has created 1944 blog entries.

Montana

LC 1633, related to 340B, was a prefile for the 2023 state legislative session. As drafted, PBMs or health insurers may not:  

  • Prohibit federally certified health entities or pharmacies from participating in the insurer’s network;  
  • Reimburse a federally certified health entity or pharmacy differently than reimbursing other similarly situated pharmacies;  
  • Require a claim or a drug to include a modifier to indicate that the drug is a 340B drug, unless the claim is for Medicaid payment; or 
  • Create restrictions or impose additional charges on patients who choose to receive drugs from a federally certified health entity or pharmacy  

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

2023-01-13T12:02:13-05:00January 13, 2023|Montana|

North Carolina

This is advance notice of reprocessing information that will be sent to affected providers on or about January 17. Due to a system error with the generic dispensing fee, pharmacy claims were paid incorrectly. The affected claims will be reprocessed to apply the correct rate. This reprocessing notice applies to pharmacy claims that were processed and paid in NCTracks from November 1, 2013, through April 7, 2014. The affected claims will be systematically reprocessed as adjustments. No provider action is required. Applicable claims will be reprocessed in the February 7 check write. For more information, visit NCTracks here.  

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

Ohio: The Ohio Department of Medicaid (ODM) and Gainwell Technologies, the Single Pharmacy Benefit Manager, are continuing the re-implementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations, and does not apply to those patients who have previously taken the drug supported by recent claims history prior to January 17. Phase 2 of reimplementation will begin on January 17 and encompass the following drug classes:  

Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see the products that require prior authorization. Prior authorizations may be submitted via phone, fax, mail and the SPBM portal. Additional prior authorizations are planned for reimplementation in a similar, incremental fashion during the first quarter of 2023. For questions, contact the Gainwell Help Desk at 1-833-491-0344.  

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

2023-01-13T12:01:38-05:00January 13, 2023|North Carolina|

Pennsylvania

Gov.-elect Josh Shapiro (D) has named Valerie Arkoosh, an anesthesiologist and chair of the Montgomery County Commissioners, as his Secretary of the Department of Human Services. Arkoosh led her county’s response in the early days of the coronavirus pandemic, which elevated her to the spotlight as Montgomery County was in the epicenter of the virus’ spread. She also has been a professor of anesthesiology and obstetrics and pitched an unsuccessful run for Congress in 2014 before being re-elected to the County Commission. He also named: 

  • Secretary of Health: Debra Bogen, a pediatrician, and the director of the Allegheny County Health Department. 
  • Secretary of Drugs and Alcohol: Latika Davis-Jones, senior director of behavioral health at Highmark Wholecare, a Medicaid managed care provider in southwest Pennsylvania. 
  • Secretary of Aging: Jason Kavulich, Lackawanna County Director of Agency on Aging. 
  • Insurance Commissioner: Mike Humphreys, who has held the role temporarily since last spring. 

Also in Pennsylvania, the Department of Human Services (DHS) issued a Medicaid bulletin announcing they will be reinstating pre-COVID provider enrollment requirements effective February 27, 2023; while the PACE Program announced their Part D pharmacy benefit plan partners for 2023. 

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

2023-01-13T12:00:54-05:00January 13, 2023|Pennsylvania|

South Carolina

Centers for Medicare and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2023 will be $688. This fee is required by CMS with any applicable Healthy Connections Medicaid provider enrollment application.  

The South Carolina Department of Health and Human Services (SCDHHS) will collect the application fee before executing a provider agreement. The fee applies to initial enrollment, reactivation, revalidation, or addition of a new practice location. SCDHHS has contracted with the SC.gov Enterprise Payment System to facilitate collection of the application fee. Payments may be made by debit, credit, or e-check. Paper checks will not be accepted. More information on payment options can be found by visiting www.scdhhs.gov/provider and selecting, “Online Application Fee Payment.”  

The provider enrollment application fee is only applicable to providers CMS has identified as institutional providers. South Carolina Healthy Connections Medicaid recognizes and enrolls the following institutional providers: Ambulatory Surgery Centers, Community Mental Health Centers, Comprehensive Outpatient Rehabilitation Facilities, Durable Medical Equipment, End Stage Renal Disease Facilities, Federally Qualified Health Centers, Home Health Agencies, Hospice, Hospitals, Independent Clinical Laboratories, Pharmacies, Skilled Nursing Facilities and Rural Health Clinics. For more information, please see the Bulletin.  

Also in South Carolina, the South Carolina Department of Social Services (SCDSS) is announcing an end to the federally approved Supplemental Nutrition Assistance Program (SNAP) emergency allotments (supplements) to all South Carolina households effective January 31. Since March 2020, the assignment of emergency SNAP allotments (supplements) has brought all authorized households up to the maximum benefit allotment, based on household size. 

January 2023 has been approved by the United States Department of Agriculture Food and Nutrition Services as South Carolina’s “transition” month, prior to going back to normal SNAP benefit allotments for all households. 

Effective February 1, all SNAP households will go back to receiving their regular monthly benefit amount.

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

2023-01-13T11:57:55-05:00January 13, 2023|South Carolina|

Texas

The state legislature will convene its 140-day biennial session on January 10, 2023. Rep. Dade Phelan (R) was elected Speaker of the House. 

Also in Texas, the State Comptroller Glenn Hegar (R) announced on January 9 that the state has a $32.7 billion surplus.  

Also in Texas, the Health and Human Services Commission’s (HHSC) Executive Commissioner Cecile Erwin Young announced that Dr. Jennifer Shuford would serve as Commissioner of the Texas Department of State Health Services (DSHS), replacing Dr. John Hellerstedt. Previously Shuford served as chief state epidemiologist at DSHS. 

Finally in Texas, several bills of interest to pharmacies have been filed: 

  • HB 1105 by Rep. Four Price (R) would make 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.  
  • HB 1293 by Rep. Toni Rose (D), the Medicaid transparency reimbursement bill, would establish a rate floor for Medicaid MCOs. 
  • SB 160 by Sen. Charles Perry (R) would provide for pharmacists to furnish medications for flu, strep and COVID under a written protocol with additional training, if identified through a CLIA Waived test. Also, it would allow for a physician to dispense drugs for flu, step and COVID, if identified through a CLIA-waived test, and dispense all antibiotics and drugs authorized under an emergency rule. 

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

2023-01-13T11:55:37-05:00January 13, 2023|Texas|

Washington

The legislature convened on January 9, 2023. 

Also in Washington, legislation creating a new stand-alone chapter for regulating PBMs was filed this week. SB 5213 and HB 1253 were designed by the Office of the Insurance Commission (IOC) and the Washington State Pharmacy Association (WSPA) to regulate PBMs directly regardless of whether the contract is with a state-regulated plan or a self-funded plan. The bill prohibits requiring the use of mail-order pharmacies (except for specialty drugs), reimbursing pharmacies below costs and excluding pharmacies from the network. 

Also in Washington, the Washington State Pharmacy Association (WSPA) Legislative Days are January 25 and February 13. These events will allow all pharmacists, pharmacy students and pharmacy technicians from all practice settings to connect with legislators and colleagues across the state. 

Also in Washington, the Health Care Authority recently updated its provider billing guides and fee schedules for Apple Health (Medicaid). 

Finally in Washington, the Department of Health (DOH) is developing a campaign in 2023 to encourage families to catch up on immunizations. To accomplish this goal, DOH is surveying health care providers for guidance on what materials and resources are needed. 

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

2023-01-13T11:53:55-05:00January 13, 2023|Washington|

California

Last week, the Department of Health Care Services (DHCS) announced plans for the reinstatement of prior authorization and the retirement of the transition policy taking place in a series of phases… II, III and IV. A webpage has been developed for “Medi-Cal Rx Reinstatement” that includes information about the timeline, key days, announcements and alerts and resources. If you already receive Medi-Cal Rx alerts, you will also begin to receive Reinstatement alerts. There is no need to subscribe to an additional listserv according to DHCS staff. 

Also in California, the DHCS posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the reinstatement resources in New Resources for Reinstatement Education and Support. 

Also in California, Medi-Cal posted the following:   

Finally in California, NACDS and the California Retailers Association (CRA) sent several joint letters to the Board of Pharmacy addressing issues of concern to members.  

  • With respect to e-prescribing requirements effective January 1, 2023, NACDS and CRA are seeking guidance from the Board about how members can comply with requirements to accept electronic prescriptions without advance notice from a vendor with whom they do not have a current business relationship.  
  • We are also seeking clarity from the Board via answers to a brief list of questions to provide members the appropriate guidance to aid their efforts to comply with a 2021 law related to pharmacy quotas; recall, this law only applies to companies operating 75 or more pharmacies in the state under one ownership.  
  • Finally, we are expressing concern with a proposal under consideration by the board to create a “staffing floor” that may lead to pharmacy closures if at least one clerk or pharmacy technician is not on staff and fully dedicated to performing pharmacy-related services while the pharmacy is open; this proposal would also permit the pharmacist on duty to close the pharmacy if, in their opinion, the staffing at the pharmacy is inadequate to safely fill or dispense prescriptions or provide services in a safe manner without fear of retaliation. We asked to work with the board on solutions so that pharmacies can remain open to their patients.

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

2022-12-16T10:35:24-05:00December 16, 2022|California|

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