The Department of Human Services published INFORMATIONAL LETTER NO. 2305-MC-FFS-CVD to inform providers about pharmacy coverage of oral COVID-19 therapeutics. See “Pharmacy Coverage Summary” on page 2.
Also in Iowa, the Board of Pharmacy published its November 10, 2021 meeting minutes.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rep. Steve Sheldon (R) has introduced legislation to comprehensively regulate Pharmacy Benefit Managers. House Bill 203 would regulate PBMs in commercial and self-insured plans, as well as the state employee plan. The bill includes patient choice of pharmacy protections and measures that protect pharmacy reimbursed. It would also prohibit mandatory mail order, require any rebates to reduce patients’ out-of-pocket costs and set a pharmacy reimbursement floor based on NADAC + professional dispensing fee. Additionally, it would require PBMs to treat 340B claims like other prescription claims for reimbursement purposes.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Referencing the federal law and regulations, the Board of Pharmacy’s Regulation Revision Committee sent to the full Board for final consideration at the February 16 meeting draft CLIA guidelines confirming that properly credentialed pharmacies may perform moderately complex lab testing.
Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing issued a Provider Update on reimbursement for COVID-19 booster shots and third doses for Medicaid Fee for Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs). Effective January 18th, Louisiana Medicaid will reimburse enrolled pharmacies for the administration fee or $37.08 or billed charges, and not for the ingredient for COVID-19 vaccines. No dispensing fee shall be reimbursed.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Maryland Insurance Administration (MIA) has released its report on the impact of Rutledge v. PCMA and the subsequent Webhi decision on Maryland law and the MIA’s ability to regulate Pharmacy Benefits Managers (PBMs) and their relationship with pharmacies in Maryland. The report was mandated by the passage of HB 601 of 2021. It concluded that, should the legislature pass legislation regulating PBMs when providing services to an ERISA plan, ERISA would not preempt the MIA’s enforcement of those laws. The report also provides a summary of previously passed laws related to PBMs in Maryland and MIA’s current methods of enforcing them. The report cites comments from NACDS and the Maryland Association of Chain Drug Stores submitted last fall, which highlighted examples of pro-pharmacy laws that align with the Rutledge decision.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Gov. Parson’s (R) ended the COVID-19 State of Emergency on December 31, 2021, ending all remaining COVID-19 related waivers authorized under EO 21-09. The Board of Pharmacy issued guidance on the expiration of the Emergency Declaration.
Also in Missouri, the Department of Social Services MO Health Net (Medicaid) clarified reimbursement for COVID-19 antiviral treatment. Pharmacy providers filling prescriptions for Paxlovid or molnupiravir will be reimbursed the current professional dispensing fee at the time the prescription is dispensed. For pharmacies to receive the full dispensing fee, the Usual & Customary charge submitted to MO HealthNet must be more than the current professional dispensing fee. Non-pharmacy providers such as clinics, hospitals, and ERs do not receive a professional dispensing fee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Effective January 1, 2022, prescribers shall use electronic prescription technology for controlled substance prescriptions with exceptions.
Also in Nebraska, the Department of Health and Human Services announced the next COVID-19 Medicaid Provider call will take place on January 19 at noon (Central).
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Board of Pharmacy is accepting comments on proposed revisions of the unused drugs program. Comments are due by February 16, 2022.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Board of Pharmacy has adopted regulations on opioid warning labels. These regulations are effective January 3, 2022.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Department of Health renewed the order requiring wearing masks indoors.
For more information, contact NACDS’ Mary Staples at 817-442-1155.