Michael Silber, Author at In The States

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So far Michael Silber has created 2568 blog entries.

Washington

The Health Care Cost Transparency Board analyzed healthcare spending from 2017 to 2023, using data from both public and commercial insurers in the All-Payer Claims Database. The analysis revealed that spending on retail pharmacies increased by 71 percent during this period, which is a significantly faster rate of growth compared to any other category of services. Rising prices were the primary driver of growth in spending on prescription drugs, with the number of prescriptions increasing by only three percent, compared to a 66 percent price increase. This study aligns with other studies that show that list prices set by manufacturers are the primary reason why costs are escalating.

Also in Washington, the Health Care Authority's (HCA) 2025-27 Operating Budget was reduced for Apple Health (Medicaid) managed care organization (MCO) rates by one percent, or approximately $90 million, for calendar year 2026. HCA provided guidance and FAQ on the managed care rate reductions effective January 1, 2026.

Also in Washington, the Health Care Authority (HCA) updated the substance use disorder (SUD) provider guide, clarifying state and federal laws that limit the use and disclosure of SUD information.

Finally in Washington, starting August 1, submitting eligibility policy questions and data requests for Eligibility Policy Innovation and Community Support (EPICS) is transitioning from the email inboxes to the ServiceNow platform, renamed to Apple Health Policy.

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

Michael Silber2025-07-31T14:56:12-04:00July 31, 2025|Washington|

California

Medi-Cal Rx shared the following information for pharmacy providers. The US Food and Drug Administration has asked the four companies that have teriparatide products (FOREO by Lilly and generics by Prasco, Teva, and Apotex) to change the package size on the label of the products. Changing package size will affect claims billing while labels with both package sizes are in distribution. Note, the product NDCs were not changed to account for the change in package size. However, the reimbursement rate was updated to account for the reduction in package size from 2.4 ml to 2.24 ml.

The Department of Health Care Services would also like to request pharmacy providers update their POS systems to allow these claims to be submitted for 2.24 ml as this change took effect on March 29. Medi-Cal Rx also asks pharmacy providers to submit claims for 2.24 ml regardless of the package size displayed on the package. This will prevent overpayment. If the pharmacy POS system does not allow the claim to be submitted for 2.24 ml, please resubmit the claim and call Medi-Cal Rx Customer Service Center for assistance. 

Also in California, the Department of Health Care Service posted the following alerts on the Medi-Cal Rx Web Portal:

Claim Submission Reminders

Now Active: NCPDP Field 426-DQ Usual and Customary Charge Requirement

Finally in California, the Board of Pharmacy issued the following: NOTICE OF DECISION NOT TO PROCEED - Pursuant to Government Code section 11347

Re: Notice of Proposed Rulemaking concerning Quality Assurance Programs

Pursuant to Government Code Section 11347, the California Board of Pharmacy (Board) hereby gives notice that it has decided not to proceed with the rulemaking action published in the California Regulatory Notice Register on August 9, 2024, Register 2024, No. 32-Z. The proposed rulemaking concerned Quality Assurance Programs (OAL Notice Z2024-0725-02).

Any interested person with questions concerning this rulemaking should contact Lori Martinez at 916-244-6648 or by e-mail at: PharmacyRulemaking@dca.ca.gov.

The Board will also post this Notice of Decision Not to Proceed on its website.

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

Michael Silber2025-07-25T11:15:33-04:00July 25, 2025|California|

Colorado

The Department of Health Care Policy and Financing (HCPF) is soliciting stakeholder input before August 30, regarding the draft Supervision Policy for Medicaid Billable Behavioral Health Services. Feedback can be provided either by attending a stakeholder meeting or providing written feedback using this Google Form.

Also in Colorado, the Department of Regulatory Agencies (DORA) Board of Pharmacy is hosting a pharmacy stakeholder meeting on proposed rules on July 31 at 9:00 am MDT. Oral comments will be taken from webinar participants. Written comments need to be submitted as soon as possible so that they can be included in this stakeholder meeting.

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

Michael Silber2025-07-25T11:14:54-04:00July 25, 2025|Colorado|

Iowa

The Department of Health and Human Services (HHS) confirmed a case of measles in an adult resident of Western Iowa and has notified the public of potential exposure locations. The individual is fully vaccinated and has no known link to the previous measles cases in Iowa, nor any recent travel outside the state. Iowa has a total of eight confirmed measles cases in 2025. For the latest information on measles in Iowa, visit the Iowa HHS Center for Acute Disease Epidemiology disease information page. This page is updated weekly, on Thursdays, with current case counts and public health guidance. 

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

Michael Silber2025-07-25T11:14:24-04:00July 25, 2025|Iowa|

Kentucky

MedImpact distributed an updated statewide naloxone protocol. Please note that the protocol requires pharmacies to notify the Department for Public Health when initiating participation under the statewide protocol by emailing or faxing (502-564-9377) the signed protocol within seven days of dispensing naloxone.

Also in Kentucky, MedImpact issued a bulletin detailing NADAC pricing and the process for reversing and refilling claims when drug prices increase.

Also in Kentucky, 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.

Finally 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.

Michael Silber2025-07-25T11:13:50-04:00July 25, 2025|Kentucky|

Louisiana

Gov. Jeff Landry (R) signed several bills into law that impact pharmacies, including:

HB 15/Act 121, effective August 1, updates the state's controlled substance schedules to align with recent federal scheduling actions taken since the last legislative session. Three substances were added to Schedule I, including two opiates and one stimulant.

HB 210 /Act 159, effective August 1, establishes provisions for the retention, archiving and destruction of certain information within the state's Prescription Monitoring Program.

SB 19 /Act 464, effective June 20, 2025, authorizes pharmacists to dispense ivermectin to individuals aged 18 years and older under a standing order issued by a Department of Health (LDH) healthcare professional with prescriptive authority. LDH must first adopt rules outlining the procedures for dispensing ivermectin.

SB 154 /Act 41, effective August 1, defines "Kratom" and classifies 7- hydroxymitragynine and mitragynine as Schedule I controlled substances in the state. The Act also adds Mitragyna speciosa to the state's list of prohibited plants.

HB 690 /Act 396, effective June 20, 2025, directs the State Surgeon General to develop rules for the administration of medical activities under Emergency Use Authorization (EUA) or all members of the healthcare community in the state. These rules will not override federal regulations but will provide state specific guidance to promote uniformity and safety in administration.

HB 264 /Act 474, effective June 20, 2025, introduces several key reforms regulating PBMs in the state.

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

Michael Silber2025-07-25T11:13:05-04:00July 25, 2025|Louisiana|

Maryland

The Medicaid Office of Pharmacy Services (OPS) issued an advisory this week reminding Medicaid-enrolled pharmacies about the regulatory requirements for returning an unclaimed prescription to stock. According to COMAR 10.09.03.03 (M), pharmacies are required to reverse invoice charges for any prescription not picked up by the participant or their designee within 14 days of dispensing the opioid antagonist. The 14-day period begins at the date of service (dispensing). The advisory cautioned that they are actively monitoring claim reversals and that signs of non-compliance may trigger audits and further review.

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

Michael Silber2025-07-25T11:11:06-04:00July 25, 2025|Maryland|

Oregon

The August 6-8 Board of Pharmacy meeting agenda and meeting materials are available. Please note on August 6, the board will meet in Executive Session for most of the day and anticipates resuming Open Session around 4:30 pm. Also note on August 7, the board anticipates meeting in Executive Session after roll call and resuming Open Session at 1:00 pm.

Finally, the board anticipates meeting in Open Session on August 8 and will break for lunch between 12 noon to 1:00 pm. Please see the meeting agenda for additional information. Additional meeting materials may be added to the agenda prior to the board meeting. Visit the board website for current meeting materials. 

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

Michael Silber2025-07-25T11:10:39-04:00July 25, 2025|Oregon|

Pennsylvania

The Board of Pharmacy has posted the application for pharmacists seeking temporary provisional licenses. The process was required by Act 34 of 2025, the recently enacted bill intended to provide relief to pharmacies experiencing increased workloads due to pharmacy closures.

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

Michael Silber2025-07-25T11:10:00-04:00July 25, 2025|Pennsylvania|