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Montana

Based on the annual survey conducted by the Department of Public Health, this year's survey results provide data to support a proposed minimum dispensing fee of $5.11. Also, the maximum dispensing fee, for each volume range, is proposed to increase to incorporate the legislatively approved provider rate increase. 

The Department of Public Health and Human Services issued a Notice of Public Hearing on Proposed Amendment to ARM 37.85.105, updating effective dates of Medicaid fee schedules effective July 1, 2023. The public hearing via remote conferencing will be held on July 27 at 9:00 a.m. Below are the proposed changes to pharmacy reimbursement. 

(f)The outpatient drugs reimbursement dispensing fees range, as provided in ARM 37.86.1105(3)(b) is effective July 1, 2022 July 1, 2023: 

(i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $4.32 $5.11 and the maximum is $15.73 $16.36;  

(ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $4.32 $5.11 and the maximum is $13.62 $14.16; or  

(iii) for pharmacies with prescription volume greater than or equal to 70,000, the minimum is $4.32 $5.11 and the maximum is $11.52 $11.98.  

(g) remains the same.  

(h) The outpatient drugs reimbursement vaccine administration fee, as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $15.65 $18.65 for each additional administered vaccine, effective July 1, 2022 July 1, 2023. 

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

2023-07-21T10:48:43-04:00July 21, 2023|Montana|

Nebraska

The Department of Health and Human Services (DHHS) posted the following: 

  • COVID-19 Provider Update Call on August 2 at noon (Central): Join using the link or dialing by phone:  

https://sonvideo.webex.com/sonvideo/j.php?MTID=mc307e2dda218d1060adfed7f454cfc16 or 408-418-9388 (access code: 2480 661 3098​)  

  • Durable Medical Equipment, Medical Supplies, Orthotics and Prosthetics effective July 1, 2023: 
  • Injectables Fee Schedule effective July 1, 2023 

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

2023-07-21T10:47:58-04:00July 21, 2023|Nebraska|

New Jersey

On July 10, Gov. Phil Murphy (D) signed a package of bills targeting prescription drug costs. Most relevant was A536, an Act Concerning Pharmacy Benefit Managers (PBMs). This new law establishes greater oversight of PBMs. The act requires rebates to be used to lower premiums and out-of-pocket costs for consumers and prevents the practice of spread pricing. It also requires PBMs to apply for a license from the NJ Department of Banking & Insurance to strengthen regulatory oversight. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

2023-07-21T10:46:42-04:00July 21, 2023|New Jersey|

New York

On July 17, the State Department of Financial Services adopted an amendment to the final rule regarding the PBM regulations and entities filing by electronic submissions.  

On July 13, the State Department of Health's NYRx, the Medicaid Pharmacy Benefit Program, posted a program update for providers and prescribers. On July 14, they also announced prior authorization program updates. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

2023-07-21T10:46:10-04:00July 21, 2023|New York|

Oklahoma

The Board of Pharmacy's COVID-19 Waiver Request form that helped pharmacies navigate through challenging times during the pandemic has been changed to a "Waiver Request" form. 

Also in Oklahoma, the Bureau of Narcotics and Dangerous Drugs Control passed a law defining "Acceptable IDs for CDS Prescriptions," changing the definition of recipient's identification number and recipient's agent's identification number for acceptable forms of identification for obtaining a controlled dangerous substance (CDS) prescription. The definition now refers to a federal law, which is 8 Code of Federal Regulations (CFR) 274a.2(b) (1)(v)(A) and (B). Title 63 O.S. §2-309B. 7. "Recipient's identification number" and "recipient's agent's identification number" means the unique number contained on forms of identification listed in 8 CFR 274a.2(b) (1)(v)(A) and (B). 

Also in Oklahoma, the Attorney General is staffing up in preparation to taking over enforcement of PBM laws. 

Finally in Oklahoma, the Board of Pharmacy held a hearing on July 19.  

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

2023-07-21T10:44:53-04:00July 21, 2023|Oklahoma|

Oregon

Gov. Tina Kotek (D) signed SB 608, requiring the Oregon Health Authority (Medicaid) to conduct a cost of dispensing study every three years and the first study is due January 2, 2024. 

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

2023-07-21T10:44:18-04:00July 21, 2023|Oregon|

Rhode Island

Medicaid is preparing to implement the Real Time 270/271 Eligibility Verification Request and Response and Real Time 276/277 Claim Status Request and Response Transactions. For Real Time transactions, the sender remains connected while the receiver processes the transactions and returns a response to the sender and with an average response time within 20 seconds. Gainwell will utilize a Real Time Safe Harbor interface referred to as HDE (Health Direct EDI). This will allow for trading partners to transmit the Real Time transactions directly to the translator (EDIaaS). 

 HDE connectivity and requirements per CAQH Core Rules 

  • Trading Partner Software web service to process transaction 
  • Trading Partner transaction can be in SoapUI or MIME format for submission
  • Trading Partner will receive a URL, HDE username and password to access the HDE connection. 

What does this mean? If you are a provider, contact your software vendor, clearing house or billing agency. Medicaid does not offer software for these Real Time transactions.  

To participate  

  • Do you have a trading partner number?  
  • Is your contact information on the Healthcare Portal current? 
  • If you have answered yes to the above questions and are interested in these Real Time transactions, please answer the questions below. 

Testing will begin late July to mid-August. 

To participate in testing, you must provide the information below. 

Name, TPID, contact name, email, and telephone number. Identify format (SOAPUI or MIME) for submitting Real Time transactions.  

Send your answers to riediservices@gainwelltechnologies.com. Please make sure to add a subject line of Real Time Transactions.  

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

2023-07-21T10:43:46-04:00July 21, 2023|Rhode Island|

South Carolina

The Department of Health and Human Services (SCDHHS) consistently offers free training to prospective and enrolled Healthy Connections Medicaid providers. Many of these courses are available virtually. Information about the upcoming Healthy Connections Medicaid eLearning trainings for summer 2023 is listed here. These recurring virtual workshops cover a variety of topics including training on Medicaid basics, how to submit claims using the web-based tool and third-party liability (TPL). To register for a workshop, please visit the Medicaid eLearning site, www.medicaidelearning.com, or call (888) 289-0709 and select option 1. Additional training resources for providers are also available online through the Medicaid eLearning site. 

Also in South Carolina, on July 18, 2023, CVS Pharmacy reached out to the Medical University of South Carolina to authenticate a hardcopy prescription for Promethazine DM (in a 473 ml bottle) and Tessalon Perles. The medical provider listed on the prescription was Dr. Chitra Lal. During the verification process, concerns were raised regarding the signature on the prescription. It was observed that the signature was not a conventional 'wet' signature and appeared to deviate from Dr. Lal's usual signature style. This discrepancy prompted a deeper investigation into the matter. Upon further examination, it was established that the prescription in question was a forgery. Rx verification should be requested by calling 864.255.5638. 

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

2023-07-21T10:42:57-04:00July 21, 2023|South Carolina|
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