Pennsylvania
The PACE program issued a bulletin to remind pharmacies about its procedure for submitting valid claim data to determine other coverage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Tennessee
The Department of Health (TDH) is monitoring a small, localized outbreak of measles in East Tennessee. At this time, the transmission has been limited and associated with known epidemiologic links; there is no evidence of widespread transmission. Clinicians should: (1) rapidly identify suspected measles infections, (2) isolate patients quickly and (3) immediately inform public health by reporting suspected measles cases to the Department of Health at 615-741-7247.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The Department of Health Care Services (DHCS) posted the following on the Medi-Cal Rx Web Portal. Please note the following items: 1.) On January 1, 2027, the DHCS will transition approximately 2 million Medi-Cal members with Unsatisfactory Immigration Status (UIS) from the Medi-Cal managed care delivery system to Medi-Cal fee-for-service (FFS). Pharmacy providers and prescribers can also review the Policy Guide for Transition of the Unsatisfactory Immigration Status Population from Managed Care to Medi-Cal Fee-for-Service to understand the upcoming changes and prepare for the transition. See "Fee-for-Service Transition Town Hall" for details. 2.) Please review in its entirety the "Update: Include ICD-10-CM Diagnosis Codes on Pharmacy Claims".
- Fee-for-Service Transition Town Hall – September 30 at 10:00 am PT
- Ordering, Referring, and Prescribing Enrollment Requirements Town Hall – September 24 at 10:30 am PT
Also in California, the Board of Pharmacy posted the agenda and meeting materials for the Licensing Committee meeting being held on September 23. Of interest, the board will discuss changes in pharmacy law included in AB 1503 (Chapter 196, Statutes of 2025), including updates on implementation activities.
Finally in California, Medi-Cal is offering a new course titled Medication Therapy Management (MTM) Live Webinar (IO105LW). The course will provide information to registered outpatient pharmacies about certain clinical services, such as reviews of a Medi-Cal member's medications, member education (for example, about how to correctly use medication) and follow-ups with members to ensure treatment efficacy.
Webinars for the MTM training will be held on the following dates:
- October 7 at 10:00 am
- October 27 at 10:00 am
Providers must register for the webinar through the Medi-Cal Learning Portal (MLP) and select the session they plan to complete to ensure enrollment.
Note: To register for the course, providers must have internet access and a user profile in the MLP. Google Chrome is the recommended web browser for accessing the MLP. Detailed instructions about the registration process and accessing webinar classes are available on the Outreach & Education page of the Medi-Cal Providers website.
For additional assistance, contact the Telephone Service Center (TSC) at 1-800-541-5555.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Public Health and Environment (CDPHE) re-issued the state's COVID-19 vaccine standing order, allowing healthcare providers, including pharmacists, to administer updated COVID-19 vaccines without individual prescriptions.
Also in Colorado, the Board of Pharmacy will hold a permanent rulemaking webinar hearing on October 1 to decide on proposed revisions to multiple rules as follows:
- Rule 2.00.00. The purpose is to align the controlled substance transfer rule with new federal DEA requirements and clarifications.
- Rules 3. The purpose is to implement Colorado House Bill 26-1336.
- Rules 10.00.00 and 14.00.00. The proposed revisions implement Colorado House Bill 26-1220.
- Rule 11.00.00. The purpose is to align system automation and the transfer of controlled substance prescriptions with new DEA requirements and practice standards.
- Rules 3, 15 and 21. These amendments refine compounding rules to better align with recent FDA guidance and implement Colorado House Bill 26-1198.
- Repeal of Rule 28.00.00. The purpose of the repeal is to implement Colorado House Bill 26-1182.
- Rule 19.00.00 – The purpose is to implement Colorado Senate Bill 26-032.
- Rule 23. The purpose is to refine and define how long PDMP data is retained and/or archived to better align with other states and reduce risk where necessary.
- Correction to Appendix G. The purpose is to change the word provider to patient, as it was originally intended and adopted by the Board.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Florida
The Agency previously announced effective October 1, the operation of the Children's Medical Services (CMS) Plan will move from Sunshine State Health Plan, Inc. (Sunshine) to Molina Healthcare of Florida, Inc. (Molina).
To ensure no disruption in current services and to support continuity of care, Molina will allow enrollees to continue receiving their Medicaid-covered authorized prescriptions through their current provider until the prescriptions expire or can be transferred to a provider in the plan's network.
Pharmacies should follow the process outlined below to receive reimbursement for services provided to a CMS Plan enrollee.
Effective October 1, pharmacies should bill Molina's Pharmacy Benefits Manager (PBM) for CMS Plan enrollees. If a pharmacy inadvertently bills Sunshine and receives a denial, the pharmacy should immediately bill Molina's PBM using the information below to process the claim(s). The pharmacy may ask the enrollee to provide their new membership card to obtain the health plan billing information.
Molina: CVS Caremark
- PBM Services Pharmacy Help Desk: 1-855-276-6580
- Group Number: RX51EN, RX51EP
- BIN Number: 004336
- PCN Number: MCAIDADV
For member questions regarding this transition, contact Molina Member Services at 1-800-262-0750. For provider questions regarding this transition, contact Molina Provider Services at 1-855-322-4076.
If enrollees encounter any issues, please refer them to the Medicaid Help Line at 1-877-254-1055 (TDD 1-866-467-4970).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Kansas
All pharmacy technician registrations expiring on October 31, must complete 20 hours of ACPE/Board-approved continuing education before renewal. Pharmacy Technicians can renew online.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
On September 14, the Department of Insurance filed an emergency regulation in accordance with SB 188 of 2024, a comprehensive commercial market PBM reform law that included a rate floor of NADAC + a professional dispensing fee as determined by a Department of Insurance cost of dispensing study. The Department’s study determined the cost of dispensing to be $16.31. The rule, effective upon filing, will require commercial insurers and the State Employee Health Plan to pay a professional dispensing fee of $16.31 per claim to all ambulatory pharmacies beginning January 1, 2027. The regulation will remain in effect until a subsequent ordinary regulation is finalized.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health (LDH) Medicaid Pharmacy Program announced that, effective September 15, it will reimburse enrolled pharmacies for influenza vaccines and administration of the vaccines for the 2026-2027 Influenza Season to Medicaid recipients who are nineteen years of age or older when the administering pharmacist is an enrolled Medicaid provider.
Also in Louisiana, LDH announced that Healthy Blue will exit at the conclusion of its Medicaid managed care contract, effective December 31, 2026.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The Prescription Drug Affordability Board’s (PDAB) next meeting is on September 28 at 2:00 pm. Registration is required to attend remotely. The agenda, as well as information about providing public comments, can be found on the PDAB’s website.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.