Michael Silber, Author at In The States

Iowa

The Department of Health and Human Services published INFORMATIONAL LETTER NO. 2428-MC-FFS with April 2023 Iowa Medicaid Pharmacy Program Changes related to the following:

New Drug Prior Authorization (PA) Criteria
Changes to Existing PA Criteria
Removal of PA Criteria
Point-of-Sale Billing Updates
DUR [Drug Utilization Review] Update

Also in Iowa, effective April 1, the Department of Health, and Human Services (Iowa HHS) will no longer require positive COVID-19 tests to be reported to the state Public Health Division. Since the development and widespread availability of rapid in-home tests – which are not required to be reported – the case and positive test counts in the state are no longer as meaningful as they once were. Iowa has no mandatory reporting order for any other respiratory viral illnesses such as influenza, RSV, and rhinovirus.

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

Michael Silber2023-03-03T10:09:48-05:00March 3, 2023|Iowa|

Montana

HB 710, legislation permitting pharmacy interns and technicians to administer immunizations, was introduced on February 21 and passed the Business and Labor Committee on February 24. After SB 239 failed to advance, the Montana Retail Association and the Montana Pharmacy Association found a new sponsor to pursue this legislation.

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

Michael Silber2023-03-03T10:08:16-05:00March 3, 2023|Montana|

Nebraska

The Department of Health and Human Services (DHHS) published Provider Bulletin 23-06: Continuous Glucose Monitoring Updated Medicaid Reimbursement Policy that provides an update to Provider Bulletin 22-22 regarding coverage for eligible beneficiaries with diabetes effective January 1, 2023.

Also in Nebraska, the Board of Pharmacy posted a revised agenda for the March 6 meeting.

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

Michael Silber2023-03-03T10:07:43-05:00March 3, 2023|Nebraska|

New York

On February 21, the State Department of Health held an online seminar to update interested parties on the latest information regarding the Medicaid Pharmacy Benefit Transition from Managed Care to NYRx effective April 1. The next presentation and meeting will be March 21 at 1:00 p.m.

Also in New York, the Department of Financial Services (Department) Pharmacy Benefits Bureau (“PBB”) announced a final request for public engagement as the Department looks to develop nation-leading regulatory standards for Pharmacy Benefit Managers (PBMs).

This request asks for information on PBM audits of pharmacies, which are meant to eliminate or reduce fraud, waste, and abuse, but often are overly burdensome and costly without meeting this intended goal. Instead, pharmacy owners are taken away from providing healthcare, requiring them to review and defend claims from years in the past at the sole direction of PBMs without justification. The information collected will inform the scope of regulations necessary to ensure audits follow a clear and transparent process and have guardrails in place to meet the goal of preventing fraud, misuse, and waste. The Department is in the process of developing a series of PBM regulations that together will form the most comprehensive regulatory framework in the country.

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

Michael Silber2023-03-03T10:07:08-05:00March 3, 2023|New York|

North Dakota

Engrossed HB 1095,legislation to include comprehensive medication management services in health benefit plans, unanimously passed the House and was sent to the Senate where it was referred to the Human Services Committee. A hearing has been scheduled for March 7 at 9:00 a.m.

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

Michael Silber2023-03-03T10:06:40-05:00March 3, 2023|North Dakota|

Oregon

Dana Hittle has been appointed as the permanent Medicaid director and will oversee Oregon’s Medicaid program, including the Oregon Health Plan. Hittle previously served as interim state Medicaid director for the last two years and, before that, was deputy Medicaid director.

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

Michael Silber2023-03-03T10:06:03-05:00March 3, 2023|Oregon|

South Dakota

HB 1135, legislation related to PBMs, passed both the House and the Senate, and will be sent to the Gov. Kristi Noem (R) for her signature. This legislation includes requirements for PBM licensure, prohibits retroactive fees except in certain situations and the collection of renumeration fees and adds criteria for drugs to be placed on the MAC list.

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

Michael Silber2023-03-03T10:05:19-05:00March 3, 2023|South Dakota|

Tennessee

TennCare is now in Phase II of its plan to unwind from the Public Health Emergency. They have created a communications toolkit and offered several other resources that healthcare providers, including pharmacies, can use to share more information with TennCare patients to ensure their coverage does not fall through.

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

Michael Silber2023-03-03T10:04:35-05:00March 3, 2023|Tennessee|

Texas

Rep. Dr. Tom Oliverson (R), chair of the House Insurance Committee, filed HB 2021, legislation that applies existing law intended to protect patients and pharmacies to all PBMs operating in Texas. The PBMs and Health plans are orchestrating opposition leveraging the Texas Association of Business and the Texas State Chamber of Commerce, mounting an aggressive campaign saying that preempting ERISA hurts employer’s ability to offer quality, affordable health care and prescription options that best fit the needs of their employees.

Also in Texas, NACDS and Texas Federation of Drug Stores (TFDS) pharmacists and interns from HEB and Walgreens spent time at the Capitol meeting with new members and staff to educate them on pharmacy’s priority issues: Medicaid reimbursement rate floor and making the PREP Act flexibilities permanent by lowering the age to 3 years for pharmacists and pharmacy technicians to administer vaccinations without a prescription.

Finally, the House Public Health Committee convened an organizational meeting on February 27 to discuss an organizational meeting and will be taking invited testimony from the Texas State Board of Pharmacy (TSBP), the Texas Department of State Health Services, and the Texas Health and Human Services Commission.

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

Michael Silber2023-03-03T10:13:14-05:00March 3, 2023|Texas|

About Michael Silber