Michael Silber, Author at In The States

Florida

Governor Ron DeSantis (R) issued an Executive Order to address the cost of prescription drugs in the state. The order directs all executive agencies to include provisions in all future contracts and solicitations with PBMs (Pharmacy Benefits Managers) (Pharmacy Benefit Manager), services that include the following:

Prohibit spread pricing for all PBMs
Prohibit reimbursement claw backs for all PBMs
Directs agencies to include reporting requirements and data transparency, including a review of all rebates, payments, and relationships between pharmacies, insurers, and manufacturers
Directs all impacted agencies to amend all contracts with these same provisions.

Also in Florida, the Agency for Health Care Administration (Agency) has been implementing Referring, Ordering, Prescribing, and Attending (ROPA) requirements as directed by the 21st Century Cures Act (Cures Act) and by the Centers for Medicare and Medicaid Services (CMS). Previous provider alerts on National Provider Identifier (NPI) requirements for ROPA providers can be found on the Agency’s website in the Provider Message Archive. Providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b).

In accordance with CMS requirements, all Fee-For-Service claims submitted October 1, 2022, or after from a non-exempt provider type that do not have a ROPA provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed below, all other provider type claims must have a ROPA provider identified by NPI on the claim for reimbursement by Florida Medicaid.

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

Michael Silber2022-07-15T08:05:37-04:00July 15, 2022|Florida|

Iowa

The Iowa Medicaid Enterprise (IME) released the final July 2022 Cost of Dispensing (COD) Report with the following results:

The report reflects the mean cost of dispensing, weighted by Medicaid volume, was $10.97 per prescription for all pharmacies, including specialty pharmacies.
For non-specialty pharmacies only, the mean cost of dispensing, weighted by Medicaid volume, was $10.18 per prescription.

IME stated the current dispensing fee of $10.38 will remain in place until additional state funding is appropriated by the Legislature next session to increase the dispensing fee to $10.97. A state plan amendment (SPA) would also be required, if funding is approved, and the increase would be prospective following CMS approval of the SPA.

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

Michael Silber2022-07-15T08:05:03-04:00July 15, 2022|Iowa|

Massachusetts

The Massachusetts House of Representatives passed HB 4930 “Relative to Expanding Access to Reproductive Rights” by a vote of 136 – 17. This bill will now be considered by the State Senate. This legislation provides legal protections for Massachusetts health care providers, including pharmacists, from prosecution by out-of-state jurisdictions for legally protected health care and reproductive health care services and products provided in Massachusetts to out-of-state residents. This language is designed to protect these providers from criminal prosecution and associated civil lawsuits from states that prohibit access to legal health care and reproductive health services and products.

Also in Massachusetts, the Commonwealth’s Senate today unanimously passed SB 2955 which will allow pharmacists to prescribe, dispense and administer HIV prevention drugs. This bill now goes to the House for their consideration.

Finally in Massachusetts, the Board of Pharmacy has announced that additional guidance will be provided now that the FDA (Food and Drug Administration) (Food and Drug Administration) has updated the emergency use authorization (EUA) for Paxlovid™ to permit prescribing by pharmacists, subject to the terms of that EUA. Any prescribing must comply with the Emergency Use Authorization (EUA) and DPH’s prescribing guidance.

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

Michael Silber2022-07-15T08:04:29-04:00July 15, 2022|Massachusetts|

Mississippi

The Mississippi Division of Medicaid (DOM), on July 1, 2022, will reestablish payment methods for the ingredient costs of prescription drugs that existed prior to the July 1, 2021 rate freeze. This change will remove the freeze for dates of service on or after July 1, 2022. DOM has been in frequent communication with the Centers for Medicare and Medicaid Services (CMS) regarding State Plan Amendment 21-0018, which was submitted last year to freeze reimbursement for outpatient drugs in compliance with Senate Bill 2799 as passed during the 2021 Legislative Session. While CMS has not yet taken official action, DOM anticipates CMS will disapprove SPA 21-0018. Once this disapproval is received from CMS, DOM will reprocess fee-for-service claims for prescription drugs with dates of service between July 1, 2021, and June 30, 2022.

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

Michael Silber2022-07-15T08:03:44-04:00July 15, 2022|Mississippi|

Nebraska

The Department of Health and Human Services (DHHS) announced the new fee schedule for injectables effective July 1, 2022.

Also in Nebraska, the DHHS issued a notice of public hearing on August 8 for proposed changes to Title 471, Chapter 7 of the Nebraska Administrative Code (NAC) – Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS).

Also in Nebraska, the DHHS posted the July 12 DUR (Drug Utilization Review) Board Meeting Agenda and the May 10 Draft Minutes.

Also in Nebraska, the DHHS published Provider Bulletin 22-12: Changes to Nebraska Medicaid Preferred Drug List (PDL) effective July 22.

Finally in Nebraska, the DHHS posted the following:

July 6 COVID Update Meeting Recording

Medicaid’s next COVID update call will be held on Wednesday, August 3 at noon (Central). Call details will be added at this website one week before the call.

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

Michael Silber2022-07-15T08:03:11-04:00July 15, 2022|Nebraska|

New Hampshire

Governor Sununu (R) signed NH SB 229 into law, expanding the authority of qualified pharmacy technicians to immunize. A pharmacist, pharmacy intern, [or] licensed advanced pharmacy technician, or certified pharmacy technician, under the supervision of an on-site immunizing pharmacist may administer influenza and a COVID-19 vaccine, if available, to the public. A pharmacist, pharmacy intern, or licensed advanced pharmacy technician, under the supervision of an on-site pharmacist may administer Hemophilus influenza, hepatitis A, hepatitis B, hepatitis A and B, human papillomavirus, meningococcal, pneumococcal, tetanus, and diphtheria, varicella, zoster, MMR (measles, mumps, and rubella), and Tdap (tetanus, diphtheria, and pertussis) vaccines, which have been approved by the Food and Drug Administration, to individuals 18 years of age or older as ordered by an immunizing pharmacist. This law goes into effect 90 days after July 27.

Also in New Hampshire, Governor Sununu (R) vetoed NH HB (House Bill) 1022 which would have permitted Ivermectin to be dispensed via standing order.

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

Michael Silber2022-07-15T08:02:11-04:00July 15, 2022|New Hampshire|

North Carolina

Governor Roy Cooper (D) has signed the 2022/2023 budget. Of importance to NACDS (National Association of Chain Drug Stores) members, language was added to extend from June 30, 2023, to June 30, 2026, pharmacy reimbursement being tied to the fee-for-service rate of NADAC (National Average Drug Acquisition Cost) plus a $10.24 dispensing fee. Language was also added to extend the State Health Director’s authority to issue statewide standing orders for COVID tests and vaccines until December 31, 2023 and maintains all the current statewide standing orders currently in place until rescinded by the State Health Director. This will ensure Pharmacies will continue to get reimbursed for the administration of the COVID vaccination and tests by North Carolina Medicaid. Finally, a provision was added to reauthorize the dispensing of biosimilars and the requirement for pharmacists to input patient information into a system that can be accessed by prescribers for biosimilar interchangeable. This can be achieved by processing the prescription through a PBM (Pharmacy Benefit Manager) or an electronic health record.

Also in North Carolina, the Department of Health and Human Services is establishing Community Access Points in all 100 counties where North Carolinians can find free and easy at-home tests, to meet people where they are, with the tools they need to protect themselves from COVID-19.
Community organizations interested in becoming a Community Access Point can register online. Information on where to find at-home tests is available at: covid19.ncdhhs.gov/PickUpTests. Information on how and where to find all testing locations in North Carolina is available at: covid19.ncdhhs.gov/FindTests.

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

Michael Silber2022-07-15T08:01:39-04:00July 15, 2022|North Carolina|

Ohio

On July 19 at 11am ET, the Department of Medicaid (ODM) will hold an online seminar with Myers & Stauffer to discuss the upcoming mandatory Pharmacy Cost of Dispensing Survey. NACDS emailed the information to join the online seminar to members on our Ohio list. However, if you need the call-in information, please contact Jill McCormack.

Also in Ohio, Myers & Stauffer has published the Specialty Drug list to be implemented in October concurrent with the new Single PBM program.

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

Michael Silber2022-07-15T08:00:59-04:00July 15, 2022|Ohio|

Oregon

The Board of Pharmacy posted a public notice and agenda for the Safe Pharmacy Practice Conditions Workgroup meeting scheduled for July 18.

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

Michael Silber2022-07-15T08:00:11-04:00July 15, 2022|Oregon|

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