The Department of Health and Human Services, Iowa Medicaid posted to the attention of all Medicaid Medical Providers and Pharmacies INFORMATIONAL LETTER NO. 2693-MC-FFS RE: Implementation of House File 1049-Gender Transition Surgeries or Associated Procedures effective July 1, 2025.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Department of Insurance (DOI) issued Bulletin 2025-03 to provide details regarding its enforcement of SB 188 of 2024, the comprehensive PBM commercial market reform law. As a reminder, the rate floor for chain pharmacies will not be effective until the DOI cost of dispensing study is completed.
Also in Kentucky, MedImpact issued a third reminder to pharmacies regarding recent changes to its covered diabetic supplies list.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Board of Pharmacy reminded pharmacies that effective April 1, the Surgeon General Dr. Ralph Abraham issued statewide standing orders implementing Act 657 from the 2024 legislative session authorizing the dispensing of three emergency medications: albuterol, epinephrine and naloxone. These medications are intended to support time-sensitive emergency medical situations, including acute allergic reactions (anaphylaxis), known or suspected opioid overdoses and acute respiratory distress caused by asthma or allergic reactions. The Department of Health (LDH) launched an informational webpage with key resources, including standing orders, medical protocols and dispensing request forms for each medication.
Also in Louisiana, Walmart pharmacist Jack Hall from Columbia has been named the 2025 Chain Pharmacist of the Year by his colleagues. He received this honor from the National Association of Chain Drug Stores (NACDS) during an awards ceremony held at the Louisiana Pharmacy Association's annual convention in Natchez on July 12.
Also in Louisiana, Gov. Jeff Landry (R) signed SB 19, a law allowing pharmacists to dispense ivermectin to individuals 18 years of age and older under a standing order from the Department of Health (LDH). The law also permits pharmacies to charge an administrative fee for additional services and grants civil immunity to pharmacists dispensing ivermectin per LDH rules.
Also in Louisiana, Gov. Jeff Landry (R) signed SB 182, a law that requires the Department of Health (LDH) Medicaid Managed Care Organizations (MCOs) to suspend prior authorization restrictions during a state of emergency declared by the governor. Additionally, the law mandates that Medicaid reimburse providers for medically necessary drugs, services, equipment, supplies and therapies provided to Medicaid recipients. This includes reimbursement for out-of-state providers who offer essential care to patients who have evacuated the state.
Finally in Louisiana, the Department of Health (LDH) published an Emergency Rule on Medicaid Reimbursement methodology. Effective July 1, LDH's Bureau of Health Services Financing adopted a new methodology with higher reimbursement rates for Medicaid Managed Care Organization's reimbursement and fee-for-service reimbursement rates. The Emergency Rule was adopted to better align Medicaid rates to Medicare rates.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Medicaid has announced that, effective October 1, pharmacy providers must enroll in electronic funds transfer (EFT) to receive fee-for-service pharmacy payments. After this date, paper checks will no longer be issued for pharmacy payments. This change is intended to address issues such as lost checks, payment delays and mailing time, as well as to modify payment security protocols. Providers that still need to enroll in EFT will need to first register with the Prime User Administration Console (UAC). See the UAC Quick Start Guide for step-by-step instructions on the registration process. Once registered, you will have access to the Provider Job Aid/Prime Therapeutics Financial Portal Guide which will provide step-by-step instructions on completing the EFT enrollment process. After submitting your enrollment request, you will receive a phone call within three business days to verify the information you provided. Please make every effort to complete this verification as soon as possible once contacted to avoid any delays in finalizing your enrollment. Questions should be directed to the Prime Therapeutics Provider Support Line at 1-888-277-5510, OPTION 1.
Also in Michigan, Medicaid announced via email that effective August 1, the following brand products will no longer be preferred and will be replaced by their generic alternatives on the preferred drug list (PDL). An updated Brand over Generic List will be posted soon.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
MO HealthNet announced that due to the increase in the state’s Pharmacy Reimbursement Allowance (Pharmacy Provider Tax), the adjustment to account for the Medicaid-reimbursed prescriptions increased effective July 1. In-state pharmacy providers will continue to receive a professional dispensing fee of $12.22, plus an adjustment to account for the cost of the Pharmacy Reimbursement Allowance attributable to Medicaid-reimbursed prescriptions. The professional dispensing fee plus the current adjusted amount will total $14.33. Out-of-state pharmacy providers will continue to receive a professional dispensing fee of $8.85.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Health and Human Services (DHHS) sent its fourth issuance of Summer Electronic Benefit Transfer (EBT) benefits to households with eligible school-age children. A one-time payment of $120 to purchase groceries will be issued for each eligible child, intended to cover the three summer months at $40 a month. Summer EBT benefits can be used to purchase food at grocery stores, online food retailers and farmer’s markets that accept SNAP EBT.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Gov. Joe Lombardo (R) vetoed AB 411, legislation that would have allowed a prescriber to request that the prescription label for mifepristone, misoprostol or their generic alternatives would indicate the name of the prescribing health care practice instead of the name of the prescribing practitioner.
Also in Nevada, the Board of Pharmacy posted the agenda and meeting materials for the July 16 and 17 meeting in Las Vegas.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
At its June 25 public meeting, the Board of Pharmacy issued a temporary waiver of the 72-hour dispensing limit in N.J.A.C. 13:39-7.4(a) to allow for dispensing of up to a 10-day emergency supply of non-controlled substance medications for Rite Aid patients affected by the closure of their pharmacies. This waiver may be used by any state-registered pharmacy but applies only to prescriptions for former Rite Aid patients. The waiver will be in effect until October 1. To satisfy the requirement in N.J.A.C. 13:39-7.4(a)1, after obtaining suitable identification from the patient or caregiver, the pharmacist may rely upon information on a prescription bottle containing a Rite Aid label. Pharmacists are expected to comply with all documentation requirements in the Board’s existing rules.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Effective July 15, NYRx, the Medicaid Pharmacy Program, will accept electronic prior authorization (ePA) requests via CoverMyMeds® in addition to the current phone and fax submission methods.
To learn more about CoverMyMeds® Electronic Prior Authorization for Medicaid Prescribers, please attend one of the webinars which occur on Tuesdays and Thursdays from 12:00 pm – 1:00 pm ET. View the calendar with upcoming dates and registration links.
The NYRx Education & Outreach Call Center is available by phone at 1-833-967-7310 or by email at NYRxEO@primetherapeutics.com from 8:00 am to 5:00 pm ET, Monday through Friday, excluding holidays.
In addition, the following changes will be made to the Dispense Brand Name Drug When Less Expensive Than the Generic Program:
"NuvaRing® will be REMOVED from the program, as the new manufacturer of NuvaRing® does not participate in the Medicaid Drug Rebate Program (MDRP)." In conformance with State Education Law, a pharmacist shall dispense a less expensive, therapeutically equivalent drug containing the same active ingredients, dosage form and strength as the drug prescribed/ordered. This includes substituting the brand name drug when NYRx has determined it to be the less expensive alternative for the patient. Brand name drugs included in this program:
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
