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So far Michael Silber has created 1944 blog entries.

Vermont

The Department of Vermont Health Access (DVHA) previously reported that Change Healthcare (CHC), which operates Vermont’s Medicaid pharmacy claims system, experienced a significant cybersecurity issue on February 21, 2024. To reduce pharmacy and provider burden and allow for claims processing, DVHA temporarily removed select reject codes. DVHA thanks pharmacy providers for continuing to support members and for following VT Medicaid policies and requirements. Although pharmacy prior authorizations are not back to full functionality, providers are reminded to refer to the Preferred Drug List (PDL) & Clinical Criteria. This will help ensure smooth transitions when prior authorizations become available again. Please note, DVHA continues to prefer brands in some cases as these agents have lower net cost to the state. Examples:  

PREFERRED AGENTS  

  • SUBOXONE® sublingual FILM  
  • VYVANSE ® (lisdexamfetamine) capsule QTY LIMIT: 1 cap /day  
  • ALBUTEROL HFA (Teva labeler code 00093 is the only preferred form) PROAIR® Respiclick (albuterol) VENTOLIN® HFA (albuterol) XOPENEX® HFA (levalbuterol)  
  • SYMBICORT® (budesonide/formoterol) QTY LIMIT: 9 inhalers (91.8gm)/90 days  
  • CONCERTA® (methylphenidate SA OSM IR/ER, 22:78%)  
  • ADVAIR® DISKUS (fluticasone/salmeterol) (Age ≥ 4 years) QTY LIMIT: 3 inhalers/90 days ADVAIR® HFA (fluticasone/salmeterol) (Age ≥ 12 years)  

 Vermont Medicaid advises pharmacies to contact the Optum Pharmacy Helpdesk with any questions (including Early Periodic Screening Diagnostic Treatment (EPSDT) requests) at 1-844-679-536 or email.  

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

2024-05-09T11:37:28-04:00May 9, 2024|Vermont|

Washington

NACDS was alerted that an error has occurred when the Health Care Authority (HCA) made the Retroactive Time Period payments to the pharmacies under Section 4(b) of the Washington State Medicaid lawsuit Settlement Agreement, and that HCA is taking steps to correct the error which will impact some pharmacies’ reimbursement. HCA discovered that it had overpaid 197 pharmacies while underpaying 334 pharmacies and will be correcting the erroneous payments.   

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) filed a CR-103E Emergency Rulemaking order codifying in rule the Food and Drug Administration’s (FDA) approval of certain naloxone hydrochloride nasal sprays as over the counter. PQAC considers the ongoing opioid epidemic to be a public health emergency in Washington state. This rule, filed on April 5, 2024, took effect immediately and will remain in effect for 120 days but will be refiled as needed while permanent rulemaking is in progress. 

Also in Washington, the Health Care Authority Apple Health (Medicaid) added the new over the counter (OTC) birth control pill – Norgestrel oral tablets (Opill) – to the list of covered drugs that also includes family planning supplies without a prescription, such as condoms, emergency contraception and spermicides. 

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

2024-05-09T11:36:40-04:00May 9, 2024|Washington|

Arkansas

The 94th General Assembly fiscal session convened on April 10 with Gov. Sara Huckabee Sanders (R) giving her state-of-the-state address, asking the legislature to approve a $6.3 billion budget.

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

2024-04-11T14:44:08-04:00April 11, 2024|Arkansas|

Florida

The Department of Revenue has announced that, effective June 1, 2024, the state sales tax rate imposed under section 212.031, Florida Statutes (F.S.), on the total rent charged for renting, leasing, letting, or granting a license to use real property (also known as “commercial rentals”) is reduced from 4.5% to 2.0%. Information about the proper reporting of tax due on commercial rentals is available on the Department’s website at floridarevenue.com/forms. For more information, please review the Department’s Taxpayer Information Publication.

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

2024-04-11T14:42:44-04:00April 11, 2024|Florida|

Illinois

The April 4, 2024, provider notice includes an update to pharmacies on billing for the COVID-19 vaccine administration fee. This update applies only to the Medicaid fee-for-service program for dates of service beginning September 11, 2023, through December 31, 2023. 

A September 28, 2023, provider notice stated the Department of Healthcare and Family Services (HFS) was still finalizing programming for the administration fee for the COVID-19 vaccine, and providers could not include administration fee charges on their claims at that time. Pharmacies could still provide COVID-19 vaccinations and submit claims to HFS for reimbursement for the cost of the vaccine and a professional dispensing fee, without an administration fee.  

HFS has completed part of the programming for pharmacies to receive the applicable administration fee for COVID-19 vaccines. Pharmacies can now void and rebill claims that were initially submitted without the administration fee for dates of service beginning September 11, 2023, through December 31, 2023. Pharmacies must use “MA” in the Professional Service Code Field, in addition to identifying the administration fee. 

Claims with dates of service beginning January 1, 2024, must continue to be billed without an administration fee until further notice. 

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. 

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

2024-04-11T14:42:12-04:00April 11, 2024|Illinois|

Indiana

The Family and Social Services Administration’s (FSSA) Indiana Health Coverage Programs (IHCP) announced a Roadshow at six locations throughout the state to be held April 30 through June 6, 2024. Providers are encouraged to come prepared with any policy-related questions. Please do not bring actual claims or claim-related questions to the event. 

Also in Indiana, IHCP issued a bulletin BT202434 detailing the program beginning on May 1, 2024, that will align the fee-for-service continuity of care with managed care. 

Finally, the Office of Medicaid Policy and Planning (OMPP) is hosting an informational webinar on the PathWays for Aging program April 18. OMPP staff will provide an overview of the PathWays program which is set to launch on July 1, 2024.  

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

2024-04-11T14:41:20-04:00April 11, 2024|Indiana|

Kentucky

Gov. Andy Beshear (D) signed HB 274, sponsored by pharmacist Rep. Danny Bentley (R). The bill authorizes pharmacists to order and administer vaccines to patients aged 5 years and older under a prescriber-approved protocol. The law takes effect 90 days after the General Assembly adjourns sine die. This date will officially be set by the attorney general after April 15. 

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

2024-04-11T14:40:52-04:00April 11, 2024|Kentucky|

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