Michael Silber, Author at In The States

Tennessee

TennCare has contracted with Mercer Government Human Services Consulting (Mercer) to conduct a professional cost of dispensing survey and a survey of acquisition cost data, also known as the Average Actual Acquisition Cost (AAAC) survey. Both surveys will begin on April 3, 2023, and must be submitted to Mercer no later than May 12, 2023.

All network pharmacies will be required to complete the professional cost of dispensing survey; however, only select pharmacies will also be required to complete the biannual AAAC survey.

Mercer will conduct a technical online seminar on March 20, 2023, at 10:00 AM CST to discuss both surveys and answer any provider questions. Please utilize the log in information below to join:

Link: https://mmc.zoom.us/s/92516957090?pwd=S0p3bm9JeHFGRTJ4R2NOeTZMNitnUT09

Passcode: 030511

Please feel free to direct any questions regarding the survey to (Lora.Underwood@tn.gov) or mercerrxpassage@mercer.com.

Also in Tennessee, please view the pharmacy provider notification regarding missing AAAC rates. You can contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com if you have any questions.

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

Michael Silber2023-03-10T11:02:38-05:00March 10, 2023|Tennessee|

Texas

Legislation has been filed in both the House and Senate that would prohibit the Health and Human Services Commission’s Vendor Drug Program from including any discount price offered for the prescription drug, including a discount offered through a third-party discount card when defining the price of a prescription drug for purposes of determining the Usual and Customary (U&C) reimbursement rate for Medicaid. These bills include SB 1619 by Sen. Charles Perry (R) and HB 3214 by Rep. Donna Howard (D).

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

Michael Silber2023-03-10T11:01:35-05:00March 10, 2023|Texas|

Utah

HB 288 (1st Sub.), legislation requiring a pharmacist who dispenses opioids to offer to counsel the patient or the patient’s representative on the use and availability of an opioid antagonist and offer to dispense an opioid antagonist with a prescription or under other defined criteria, passed both the House and the Senate and will be sent to Gov. Spencer Cox (R) for his consideration.

Also in Utah, SB 193, legislation that a health insurer may not require a pharmacy to dispense a clinician-administered drug directly to an enrollee with the intention that the enrollee will transport the drug to a healthcare provider for administering, passed the Senate and the House and will be sent to Gov. Cox for his consideration.

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

Michael Silber2023-03-10T11:01:02-05:00March 10, 2023|Utah|

Washington

Broad reform legislation regulating PBMs, 2SSB 5213, that was supported by the Insurance Commissioner, the Washington State Pharmacy Association, and pharmacies, which would have prohibited requiring the use of mail-order pharmacies except for specialty drugs, reimbursing pharmacies below costs and excluding pharmacies from the network, died on the Senate floor on March 8.

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

Michael Silber2023-03-10T11:00:25-05:00March 10, 2023|Washington|

Wyoming

The 2023 General Session of the 67th Wyoming Legislature adjourned on March 3.

The following bills were signed into law by Gov. Mark Gordon (R):

SF 7 (Enrolled Act No. 36), legislation amending the definition of “opiate antagonist” to mean any device or medication approved by the U.S. FDA for the treatment of an opiate drug related overdose effective immediately upon completion of all acts necessary for a bill to become law.

SF 9 (Enrolled Act No. 53), legislation authorizing payment for services rendered by a licensed pharmacist under the Medical Assistance and Services Act effective July 1, 2023.

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

Michael Silber2023-03-10T10:59:42-05:00March 10, 2023|Wyoming|

Alabama

All previously published expiration dates related to the COVID-19 public health emergency (PHE) are once again extended by the Medicaid Agency (Medicaid). The new expiration date is the earlier of March 31, 2023, or any expiration date noticed by Medicaid through a subsequent ALERT.

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

Michael Silber2023-03-03T10:12:35-05:00March 3, 2023|Alabama|

Arizona

SB 1248, legislation repealing several components of the sunrise process for scope expansion, including pharmacy, passed the Senate (21-9) and the House (42-18) and was sent to the Gov. Katie Hobbs (D) for signature. The sunrise process will require material changes to certification, registration, or licensure.

Also in Arizona, on February 20, SB 1254 (Senate Engrossed), legislation repealing the requirement for a Schedule II opioid prescription that is directly dispensed by a pharmacist and that is not for the immediate administration to the ultimate user to have a red cap, passed the Senate and was transmitted to the House.

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

Michael Silber2023-03-03T10:12:04-05:00March 3, 2023|Arizona|

California

The Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. 

Policy Update of Remdesivir (Veklury) for the Outpatient Treatment of COVID-19 as a Pharmacy Benefit (March 1)
Enteral Nutrition Update: Changes to the Published Enteral Nutrition Policy in the Medi-Cal Rx Provider Manual, Effective April 1, 2023 (March 1)
Maximum Allowable Ingredient Cost 30-day Pharmacy Provider Notice (March 1)
Pharmacy Provider Dispensing Fee Self-Attestation (March 1)
Medi-Cal Rx Monthly Bulletin for March (March 1)
Changes to Contract Drugs List (CDL) (March 1)
Changes to Contract Drugs List (CDL) – Over-the-Counter Drugs (March 1)
Updates to the Medi-Cal Rx Provider Manual (March 1)
Medi-Cal Rx Weekly Wrap-Up for February 17-23 (February 24)
Reinstatement Spotlight (February 24)
30-day Countdown – Phase III, Lift 1: Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older (February 23)
New Resources for Providers: COVID-19 Testing and Treatment Support (February 21)
Medi-Cal Rx Weekly Wrap-up for February 10-16 (February 17)
Reinstatement Spotlight (February 17)

Also in California, Medi-Cal posted the following:

CDPH Offers New Warmline for COVID-19 Testing and Treatment (March 2)
Breast and Cervical Cancer Treatment Program: End of Medi-Cal Continuous Coverage (March 1)
Medi-Cal Update – Pharmacy – February 2023 – Bulletin 1034 (

Also in California, on March 23, 2020, the DHCS published a regulatory provider bulletin (Requirements and Procedures for Emergency Medi-Cal Provider Enrollment) that established amended enrollment requirements and procedures for providers to temporarily and provisionally enroll in the Medi-Cal program during the COVID-19 public health emergency (PHE) as authorized by the Section 1135 waiver granted by the CMS. Effective March 29, 2023, DHCS is discontinuing the provider enrollment flexibilities authorized by the Section 1135 waiver. Providers will have 90 days from the end of the waiver period on March 29, to submit an application for enrollment via the Provider Application and Validation for Enrollment (PAVE) portal. Providers who have not submitted an application by June 27, will have their temporary enrollment deactivated, effective June 28.

Also in California, Magellan Rx Management posted the archived webinar for the Medi-Cal Rx Pharmacy Provider Dispensing Fee Self-Attestation that was held on February 23. This online seminar was hosted by Mercer and covered the attestation pharmacies must submit to determine the fee-for-service professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service within the state’s following fiscal year. The DHCS also posted a current version of the Pharmacy Provider Dispensing Fee Self-Attestation FAQs.

Finally in California, the Board of Pharmacy posted the agenda and meeting materials for the Medication Error Reduction and Workforce Committee Meeting on March 8. The agenda includes a presentation by Peggy Binzer, Executive Director with the Alliance for Quality Improvements and Patient Safety and a discussion of the most recent report of the Well-Being Index.

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

Michael Silber2023-03-03T10:11:27-05:00March 3, 2023|California|

Illinois

This notice relays information released from the Drug Enforcement Administration (DEA) regarding removal of the DATA Waiver (X-Waiver) requirement for practitioners prescribing buprenorphine. This information applies to customers covered under the Medicaid fee-for-service (FFS) program and by the managed care organizations (MCOs).

Previously, the federal government required practitioners with DEA licenses to also obtain a special waiver (known as an X-Waiver because the DEA Registration Number began with an X) to prescribe medications such as buprenorphine for the treatment of opioid use disorder (OUD) in office-based settings outside of federally registered opioid treatment programs. Health care providers were also restricted in the number of patients with OUD they could treat.

Section 1262 of the Consolidated Appropriations Act, 2023 (also known as the Omnibus bill), removes the federal requirement for practitioners to submit a Notice of Intent (have a waiver) to prescribe buprenorphine for the treatment of OUD. All practitioners who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for OUD. There are no longer any annual limits on the number of patients that a prescriber may treat for OUD with buprenorphine. The January 12, 2023, letter from the DEA to waiver registrants identified these changes.

Pharmacies need to be aware of this change, as HFS [Department of Healthcare and Family Services] has received complaints that prescribers without a DEA X-Waiver are having trouble getting their prescriptions honored at local pharmacies.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for the FFS population or the applicable MCO.

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

Michael Silber2023-03-03T10:10:30-05:00March 3, 2023|Illinois|

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