The Senate Health and Human Services Committee will hold hearings on June 27 to examine the impact of state and federal pandemic policies-including agency guidance, licensing and regulatory actions, and health care industry policies-on patient care and treatment delivery.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Care Authority (HCA) Director Sue Birch selected Dr. Charissa Fotinos, who has been the interim state Medicaid Director since August of 2021, as the new state Medicaid Director. Dr. Fotinos will also continue to serve as HCA behavioral health medical director.
Also in Washington, effective July 1, 2022, the Health Care Authority (HCA) is publishing quarterly updates to many of the Apple Health billing guides. Billing guides are located on HCA’s Provider billing guides and fee schedules webpage.
Finally in Washington, the State Health Care Authority (HCA) is beginning the first step of making its Medicaid Management Information System (MMIS), known as ProviderOne, more flexible and modifiable. First, HCA is working to replace the existing Pharmacy Point of Sale (POS) system. The new Pharmacy POS solution will offer the latest functionality, features, and technologies to better meet the needs of Washington’s Medicaid clients.
On the day of go‐live, fee‐for‐service pharmacy claims will no longer be billable using our current processor control number (PCN) and bank identification number (BIN). HCA will provide the new PCN/BIN as the project gets closer to go‐live. After the initial implementation, HCA will be adding functionality for pharmacies and prescribers to submit prior authorization requests through a new, secure online portal.
Sign up for the Health Care Authority’s email list to receive future updates on this project, including the go‐live date and PCN/BIN changes. If you have questions, contact pharmacyposproject@hca.wa.gov.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Effective July 1, 2022, the Alabama Medicaid Agency will:
| PDL Additions | |
| Dexmethylphenidate ER (generic) | Cerebral Stimulants/Agents Used for ADHD (attention deficit hyperactivity disorder) (Long-Acting) |
| PDL Deletions | |
| Adhansia XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
| Focalin XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
For additional PDL and coverage information, visit the drug look-up site.
The Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. The PA request form can be completed and submitted electronically on the Agency’s website.
Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescriber believes medical justification should be considered, the prescriber must document this on the form or submit a written letter of medical justification along with the PA form to Kepro. Additional information may be requested. Staff physicians will review this information.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
On June 1, Legislative Leaders announced a 2022-2023 Joint Budget Agreement that contains budget priorities from the Assembly and the Senate as well as elements of the Governor’s budget proposals. The agreement provides an overall plan to provide relief to families and small businesses, including $142.8 million over two years designated to forgive recoupment of pharmacy reimbursement rate reductions in Medi-Cal from prior years for independent pharmacies. NACDS and the California Retailers Association (CRA) have been advocating in recent months for forgiveness of the Medi-Cal Recoupments for all pharmacy providers. On June 3, NACDS and CRA submitted a joint letter to Gov. Gavin Newsom (D) urging him to allocate the $142.8 million for Medi-Cal pharmacy rate recoupment to all applicable pharmacies, including chains.
Also in California, the Department of Health Care Services posted the following alerts and notices on the Medi-Cal Rx Web Portal.
Finally in California, the Board of Pharmacy has posted the following documents for its Full Board Meeting to be held on June 16.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Maine Board of Pharmacy has released its minutes from April and May meetings. The next Board meeting will be on August 4.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Massachusetts Board of Pharmacy has updated its Policy 2022-03 which deals with unfilled Prescriptions. The Board decided to update the policy based on information from the DEA to allow pharmacies to send unfilled electronic prescriptions for federally controlled substances, including CII, to another pharmacy for initial fill. This can be done either by verbal transfer or election transmission, but methods must be pharmacist-to-pharmacist and follow the transfer requirements of 21 CFR section 1306.25. The next Board of Pharmacy meeting is scheduled for August 4.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
HF 4065, an omnibus health care bill was signed into law by Gov. Tim Walz (D). The bill includes a provision that allows pharmacists to administer intramuscular and subcutaneous drug injections and to place drug monitoring devices according to prescription, protocols, or collaborative practice agreements.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Before the New York State Legislature recently adjourned, both Houses passed legislation (A3040B-S4807B) which would authorize pharmacists to administer long-acting injectable medication for MH/SUD per a prescription or order. In addition, the legislature rejected efforts to delay or repeal the planned FFS (Fee for Service) transition of the pharmacy benefit set to take effect on April 1, 2023.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Department of Medicaid (ODM (Ohio Department of Medicaid)) has published an important update regarding the implementation of the Single Pharmacy Benefit Manager (SPBM). The update clarifies that reimbursement rates for the new program will be announced later this month, that Gainwell has launched a new webpage that includes important program information and useful guides including the SPBM Pharmacy Reference Guide (Provider Manual). The website will continue to be updated with information for members, pharmacies, and prescribers. Lastly, they have also released an updated version of their SBPM FAQ (Frequently Asked Questions), which includes answers to many questions NACDS had previously submitted on behalf of members.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.