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Michigan

NACDS reminds members that pharmacists can prescribe self-administered hormonal birth control under delegated authority, including oral contraceptives, the patch, and the ring, by opting into the program. The change happened under an interpretive statement issued by the state’s Licensing and Regulatory Affairs Department (LARA) under direction of a previous executive directive 2022-05 issued by Gov. Gretchen Whitmer (D) in May of 2021. Pharmacists must enter into a delegation agreement; a sample delegation agreement is available on LARA’s website. The governor’s executive directive in May instructed state departments and agencies to identify and assess opportunities to increase protections for reproductive health care.

Also in Michigan, on October 3, LARA issued a notice that the state will formally begin enforcing Michigan’s 2020 e-prescribing law on January 1, 2023. Though the law was originally to take effect in 2021, it included a provision allowing Bureau of Professional Licensing to delay enforcement until the federal Centers for Medicaid and Medicare (CMS) began enforcing the mandate on Part D prescription drug programs. LARA also released an Application for waiver of electronic prescribing requirements form for prescribers and posted an FAQ document. Note that pharmacists are not required to verify that a prescriber qualifies for a waiver when filling paper prescriptions.  

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

2023-01-13T12:05:51-05:00January 13, 2023|Michigan|

Missouri

The legislature convened on January 4, 2023. Several PBM reform bills have been filed, including SB 402/HB 198 and SB 26/HB 197. Also filed were two bills expanding the Pharmacy Practice Act related to the administration of medication by pharmacist including HB 331 and SB 41.

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

2023-01-13T12:04:56-05:00January 13, 2023|Missouri|

New York

On January 17, from 1:00 p.m. – 3:00 pm, the Department of Health (DOH) is hosting the next in its series of monthly stakeholder informational webinars about the transition of the pharmacy benefit from Medicaid Managed Care to Medicaid Fee for Service (NYRx). Registration is required in order to access the meeting links. Presentations from past meetings are available on the transition website. 

Also in New York, the DOH issued an update to the Medicaid Fee for Service Program “Dispense Brand Name Drug When Less Expensive Than Generic” list effective January 19. Additionally, DOH published an updated standing order for Naloxone under the signature of Dr. Sharon Stancliff. 

Finally in New York, as 2022 ended, Gov. Kathy Hochul (D) signed several bills important to pharmacy practice into law, including: 

  • S4870B authorizing pharmacists to administer certain long acting injectables (Note: rules will need to be promulgated and a new bill for 2023 with minor technical changes to the law has been agreed to.) 
  • A7469 allows for 30-day emergency refills 
  • A187 permits pro-rated cost sharing on short fills and maintains the full dispensing fee to enable medication synchronization in the state’s Medicaid program 

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

2023-01-13T12:04:24-05:00January 13, 2023|New York|

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|

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