The state Medicaid Health Coverage Programs’ (IHCP) Drug Utilization Review (DUR) Board issued several updates in the IHCP Bulletin for pharmacies.
Also in Indiana, effective August 1, the IHCP will cover COIVD-19 Vaccine Counseling as part of Early and Periodic Screening, Diagnostic and Testing (EPSDT) benefit. Coverage applies to all IHCP programs for beneficiaries under the age of 21 who are eligible for EPSDT.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Walgreens pharmacist Troy Menard, a member of the Louisiana Board of Pharmacy, was chosen by his peers and honored by NACDS at the Louisiana Pharmacist Association Annual Convention’s award ceremony as the “2022 Chain Pharmacist of the Year.” {PHOTO Left to right: Walgreens pharmacists Jeff Gaude with Troy Menard}
Also in Louisiana, effective July 1st, the Medicaid Fee for Service Pharmacy Program and Managed Care Organizations will be reduced 30-cents from $37.08 to $36.78 to align with the Medicare rate and Louisiana Medicaid Professional Services. No dispensing fee shall be reimbursed, only an administration fee. At home, administration of the COVID-19 vaccine for any dose will be increased 38-cents from $32.60 to $32.98 for a total reimbursement of $69.76 ($32.98 + $36.78) or billed charges, whichever is the lesser amount.
Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing sent a reminder memo that Medicaid will begin denying claims on December 31, 2022, for providers that have not completed the enrollment process through the Medicaid Provider Enrollment Portal by September 30.
Also In Louisiana, Gov. John Bel Edwards signed into law HB 673/Act 723 that establishes a new Pharmacy Benefit Manager Advisory Council. Both NACDS and our in-state partner, the Louisiana Alliance for Retail Pharmacies (LARP) have designated seats on the Council. The purpose of the Council is to provide monitoring of pharmacy benefit managers in Louisiana to advise the legislature, commissioner of insurance, and Board of Pharmacy on the most effective and efficient manner of regulation of pharmacy benefit managers to ensure the protection of the public.
Also in Louisiana, on July 13th both the Prescription Benefits Manager Monitoring Advisory Council (PBM-MAC) and the Pharmacy Benefit Manager Council (PMPAC) held in-person meetings in Baton Rouge. NACDS has designated seats on both Councils.
Finally in Louisiana, on July 1, Medicaid implemented a new preferred drug list (PDL). There were no new therapeutic classes added to the PDL at the spring 2022 Pharmaceutical & Therapeutics (P&T) Committee meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
As the Mississippi Division of Medicaid’s (DOM) transitions to a new Medicaid Management Information System (MMIS), the Department has announced a series of workshop webinars will be available in August and September to train providers in how to use the new system, MESA: Medicaid Enterprise System Assistance. Details about those webinars and instructions on how to register for them can be found on Gainwell Technology’s new Learning Management System (LMS), which is now available online.
Only current Medicaid-enrolled providers will be able to access the LMS and register for training (the webinars are not intended for CHIP-only providers). To verify your status as a Medicaid provider, you are asked to:
Providers can also learn more about MESA and find the latest updates and FAQs on the system implementation on DOM’s website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
On July 14, the MO HealthNet Pharmacy Program transitioned the Preferred Drug Searchable Database to a new vendor. If the new database is unavailable, providers may use the Pharmacy Clinical Edits and Preferred Drug Lists webpage.
Also in Missouri, MO HealthNet Division (MHD) will begin desk audits of providers to ensure proper billing units are used for drugs billed to MO HealthNet. Providers are responsible for proper billing of claims as outlined in Section 15 of the Pharmacy Provider Manual. Providers must have adequate documentation and these records must be made available to MO HealthNet upon request.
Also in Missouri, announced provider rate increases contingent on CMS approving the State Plan amendment (SPA). Until then, current rates remain in effect.
Finally in Missouri, Gov. Mike Parsons (R) signed into law two opioid bills effective August 28, 2022. HB 2162 expands the definition of opioid antagonists that can be dispensed under a prescriber’s protocol or standing order to include addiction mitigation medications, and MO HB 2331 allows a pharmacist to dispense and opioid antagonist under a protocol or standing order.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Medical Assistance Division (MAD) of the New Mexico Human Services Department (HSD) is requiring all prescribers including pharmacists with prescriptive authority for Centennial Care members to enroll as a Medicaid Provider by November 12, 2022, to continue to receive payment for prescriptions. Failure to enroll as a Medicaid Provider will result in denial, rejection, or recoupment of payment for prescriptions when written for Centennial Care members.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
As a result of PBM legislation enacted in 2021, the NYS Department of Financial Services is developing regulations, and the Department is seeking public comment on a series of issues.
Below are the three upcoming Public Notices with links for more details related to:
PBM Services to Medicare Part D Plans, Comments due August 1, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-02” included in the subject line. Failure to include “PBM2022-02” in the subject line may result in your comment not being considered. The deadline for responses is August 1, 2022.
Reporting Requirements for PBMs (Pharmacy Benefits Managers), Comments due August 5, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-03” included in the subject line. Failure to include “PBM2022-03” in the subject line may result in your comment(s) not being considered. The deadline for responses is August 5, 2022.
Practice of Patient Steering by PBMs due August 19, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-04” included in the subject line. Failure to include “PBM2022-04” in the subject line may result in your comment not being considered. The deadline for responses is August 19, 2022.
For more information about these Public Notices and DFS (Department of Financial Services) efforts to implement the law, please click here.
Also in New York, the Office of the Medicaid Inspector General (OMIG) published a Proposed Rule Making in the State Register related to Medicaid Program Fraud, Waste and Abuse Prevention with the stated purpose to establish requirements for providers to detect and prevent fraud, waste, and abuse in the Medicaid Program.
The full text of the proposed rule can be found here. Public comments are due within 60 days from when published on July 13, 2022. To read the new sections added to OMIG regulation through this rulemaking in their entirety, please click here.
In particular, the proposed rulemaking would repeal and add a new 18 NYCRR Part 521 to implement statutory changes resulting from the recommendations of the Medicaid Redesign Team II as adopted in the State Fiscal Year 2020-2021 Enacted Budget (Chapter 56 of the Laws of 2020, Part QQ) and to make other conforming changes related to:
(1) Provider Compliance Programs,
(2) Medicaid Managed Care Plan fraud, waste, and abuse prevention programs under the Medical Assistance (Medicaid) program, and
(3) The Obligation to report, return and explain Medicaid overpayments through OMIG’s Self-Disclosure Program.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Ohio Department of Medicaid (ODM) announced that the enhanced COVID-19 administration reimbursement rate for pharmacies will end on Sept. 30, 2022, as the new Single Pharmacy Benefits Manager (SPBM) program takes effect.
Also in Ohio, the Board of Pharmacy issued guidance on the implementation of HB 193, which mandates electronic prescribing of Schedule II controlled substances. As the guidance notes, the law has a “safe harbor” provision which allows pharmacies to continue to fill paper prescriptions without verifying that the prescriber has an exemption. The law goes into effect on Sept. 23, 2022. Special thanks to the Ohio Council of Retail Merchants for working with NACDS and members during the legislative process to ensure that the “safe harbor” provision was included in the law.
Also in Ohio, the Board of Pharmacy posted a notice regarding license renewals for Certified Pharmacy Technicians. The renewal process opens on Aug. 1, 2022.
Finally in Ohio, the following are updates/reminders on the topic of the upcoming October implementation of the SPBM:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The State Board of Pharmacy (OSBP) is requesting that pharmacies email the following information within 24 hours of pharmacy closure during normal business hours, during the time when patients would expect the pharmacy to be open.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Oregon State Newsletter – June 2022 has been posted to the NABP/Oregon website and includes the following information.
Also in Oregon, the Board of Pharmacy adopted the following temporary rules effective July 1, 2022, through December 27, 2022.
Also in Oregon, the Board of Pharmacy adopted the following permanent rules at the June 2022 Board Meeting.
Finally in Oregon, effective July 1, 2022, through December 27, 2022, the Oregon Health Authority adopted a temporary rule amending OAR 410-121-0030 and 410-121-0040 in accordance with the Drug Use Review (DUR) Pharmacy & Therapeutics (P&T) Committee’s recommendations made during the June 2, 2022 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
