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So far Michael Silber has created 2529 blog entries.

California

The Department of Health Care Service posted the following alerts on the Medi-Cal Rx Web Portal. As previously announced in the alert titled 60-Day Countdown: NCPDP Field 426-DQ Usual and Customary Charge Requirement, pharmacy providers submitting claims to Medi-Cal Rx with a date of service (DOS) on or after July 18 will be required to include their Usual and Customary (U&C) charge in NCPDP Field 426-DQ (Usual and Customary Charge). Claims submitted for the DOS on or after July 18 with a blank dollar amount or a value of $0.00 will be denied by Medi-Cal Rx with Reject Code DQ – M/I Usual and Customary Charge with the supplemental message "Resubmit claim with U&C charge in field 426-DQ."  

 Also in California, the Board of Pharmacy issued the following update regarding the California Medication Error Reporting (CAMER) system. An orientation webinar is being offered by the Institute for Safe Medication Practices (ISMP) at 1:00 pm Pacific on July 9. Also, medication errors that occur on or after September 1 must be reported to the CAMER system. For your convenience, here's a link to the CA Board of Pharmacy Medication Error Reporting System website hosted by ISMP. 

Business and Professions Code (BPC) section 4113.1 establishes requirements for a community pharmacy to report medication errors to an entity approved by the Board. The statute requiring medication error reporting by community pharmacies can be viewed at BPC section 4113.1. The Board approved ISMP, an ECRI Company, as the entity to receive and review medication error reports under BPC section 4113.1.  

Consistent with its commitment to keep licensees apprised of implementation activities related to the California Medication Error Reporting (CAMER) system, the Board is providing the following updates: 

  • ISMP will be holding an orientation webinar at 1:00 p.m. Pacific Time on July 9. Registration for the orientation webinar is available online. To view, go to FAQ and then "Will there be training or orientation sessions for how to use the reporting system and submit reports?". 
  • ISMP posted additional information related to reporting data elements. To view, go to FAQ and then "Which data elements will be built into the reporting system?". 

Also in California, the Office of Administrative Law approved the Board of Pharmacy's updated compounding regulations. The regulations describe the Board's requirements for nonsterile compounding, sterile compounding, hazardous drug and radiopharmaceutical preparations. 

The regulation is effective October 1. The Board will be releasing an updated policy statement regarding its expectations during the transition period. The Order of Adoption for the approved regulation regarding the compounding regulations has been posted.  

Also in California, the Board of Pharmacy proposes taking rulemaking action related to "Medication-Assisted Treatment Protocol". The proposed text is available for review on the Board's website. Written comments must be received by the Board no later than August 4 or must be received by the Board at the hearing, if one is scheduled. Inquiries or comments may be addressed to:  

  • Lori Martinez Address: 2720 Gateway Oaks Drive, Ste. 100, Sacramento, CA 95833; Phone: (916) 518-3100; Fax.: (916) 574-8618; or e-Mail Address: PharmacyRulemaking@dca.ca.gov   
  • The backup contact person is: Debbie Damoth Address: 2720 Gateway Oaks Drive, Ste. 100, Sacramento, CA 95833; Phone: (916) 518-3100; Fax.: (916) 574-8618; or e-Mail Address: PharmacyRulemaking@dca.ca.gov  

Finally in California, the Department of Health Care Services (DHCS) has been formally approved by the Centers for Medicare and Medicaid Services (CMS) to participate in the federal Cell and Gene Therapy (CGT) Access Model, with implementation effective July 1. This model is designed to improve access to high-cost, high-impact gene therapies for Medi-Cal members with complex conditions, starting with sickle cell disease (SCD). The initial therapies included in this model are Casgevy and Lyfgenia.  

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

2025-06-26T14:36:52-04:00June 26, 2025|California|

Indiana

The Family and Social Services Administration (FSSA) Health Coverage Programs (IHCP) issued a Bulletin documenting requirements clarified for claims billed to Medicaid for dually eligible members. 

Also in Indiana, IHCP reminded providers about the benefits of submitting claims electronically and provided pharmacy updates approved by the Office of Medicaid Policy and Planning. 

Also in Indiana, IHCP announced that effective July 1, they will expand provider enrollment to include licensed pharmacists. This new provider specialty will allow eligible pharmacists to enroll as rendering providers linked to a group provider. Group providers may be reimbursed for evaluation and management (E/M) services related to hormonal contraceptives provided by IHCP-enrolled pharmacists, as outlined in Indiana Code IC 25-26-25. 

Finally in Indiana, the Office of Medicaid Policy and Planning is seeking applicants to serve on the Medicaid Advisory Committee which provides feedback on the program policies and proposed policies that ensure the program is responsive to concerns as well as providing transparency and accountability.  

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

2025-06-26T14:35:46-04:00June 26, 2025|Indiana|

Kansas

Gov. Laura Kelly (D) appointed two new pharmacists members to the Board of Pharmacy, Joanna Robinson, PharmD, MS, BCSCP, and Janine Ohler, PharmD, BCPS. They will each serve a four-year term and are replacing Jonathan Brunswig, PharmD, and William Walden, RPh, both of whom served eight years on the board. 

Also in Kansas, SB 63 which became law earlier this year on February 20, requires in Section 4 that "if a healthcare provider violates the provisions of Section 3 of the law, the healthcare provider has engaged in unprofessional conduct and, notwithstanding any provision of law to the contrary, the license of such healthcare provider shall be revoked by the appropriate licensing entity or disciplinary review board with competent jurisdiction in this state". 

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

2025-06-26T14:35:18-04:00June 26, 2025|Kansas|

Louisiana

Gov. Jeff Landry (R) urged lawmakers during the final week of the session to amend HB 358, permitting a pharmacy technician to work remotely by Rep. Dustin Miller (R). The Governor wanted to include an amendment prohibiting PBMs from owning pharmacies. While the House quickly concurred with the Governor's language, the Senate declined to bring the bill up for a final vote on the last day of the session on June 12. Gov. Landry pledged to convene a special session this summer to encourage legislators to lower drug prices and help preserve independent pharmacies. Attorney General Liz Murrill (R) sent CVS a cease-and-desist order to prevent pharmacy benefit managers (PBMs) from lobbying customers about pending legislation and issued a statement saying she would investigate whether the text messages about the bill were appropriate. 

Also in Louisiana, lawmakers passed and sent to Gov. Landry for approval HB 264 by Rep. Michael Echols (R), prohibiting PBMs from engaging in spread pricing, patient steering and the use of effective rate pricing. The bill applies to local pharmacies only, defined as those with ownership in Louisiana of 10 or fewer pharmacies. The bill also establishes a reimbursement floor using NADAC, enhances transparency and audit protections, passes through manufacturer rebates to consumers, and grants additional enforcement authority to the Insurance Commissioner. Lastly, the proposed law modifies the composition of the Pharmacy Benefit Monitoring Advisory Council and adds a chain pharmacist appointed by the Louisiana Alliance of Retail Pharmacies (LARP). 

Also in Louisiana, Gov. Jeff Landry (R) signed HB 565 by Rep. Annie Spell (R), legislation prohibiting Medicaid managed care organizations (MCOs) from amending, modifying, or changing a claim submitted by a healthcare provider or adjusting, down coding or paying a claim at a lower level than what was submitted by the healthcare provider. To the extent MCOs violate these provisions, the Louisiana Department of Health (LDH) shall withhold payment to the MCO an amount to be determined by LDH not less than $25,000 or greater for each violation. 

Also in Louisiana, HB 690 by Rep. Charles Owens (R), requiring the state surgeon general to promulgate rules for the administration of Emergency Use Authorizations (EUA) related medical activities by all members of the healthcare community, including hospitals, public and private clinics, pharmacies, nursing homes and other entities involved in healthcare activities where EUA may apply, was sent to Gov. Jeff Landry (R). 

Also in Louisiana, House Resolution 314 by Rep. Rodney Lyons (D) requesting that the Louisiana Department of Health (LDH) provide access to vaccines and information on the diseases they prevent to areas of need, passed the House and was sent to the Secretary of State. 

Finally in Louisiana, the Department of Health published two rules in the June Register.  

  • The emergency drug kit (EDK) permit removes the requirement for the administrator of the applicant facility to sign the application for the EDK permit, and requires the online permit verification to be readily retrievable, since the board no longer issues paper permits. 
  • The Pharmacist-in-Charge (PIC) change reduces the minimum experience requirement for a pharmacist to qualify for a PIC privilege from two years of active pharmacy practice to one year. It also adds the authority and accountability of the owner of the pharmacy permit to the existing responsibility of the PIC for the complete supervision, management and compliance with laws and regulations pertaining to the practice of pharmacy of the entire prescription department. 

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

2025-06-26T14:34:50-04:00June 26, 2025|Louisiana|

Mississippi

The Board of Pharmacy is seeking a Pharmacy Benefit Manager Compliance Director. This position will oversee PBM compliance, policy development and administrative actions as directed by legislative authority regarding PBM activities, as outlined in the Pharmacy Benefit Prompt Pay Act, the Pharmacy Benefit Audit Integrity Act and other applicable state and federal laws and regulations. The individual will serve as the agency’s primary point of contact with internal and external stakeholders for PBM matters. This position welcomes applications from both non-pharmacists and pharmacists. As stated in the job description, the successful candidate’s actual salary will be based on their relevant experience.

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

2025-06-26T14:34:00-04:00June 26, 2025|Mississippi|

Missouri

The Department of Social Services MO HealthNet Division (Medicaid) adopted an emergency rule for the Pharmacy Reimbursement Allowance (PRA). The emergency amendment was filed on June 23 and takes effect on July 8 and expires February 26, 2026.

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

2025-06-26T14:33:29-04:00June 26, 2025|Missouri|

Nebraska

The Department of Health and Human Services published Provider Bulletin 25-10: Pharmacy Dispensing Fee Increase. Effective July 1, all pharmacies who fill a prescription for a Medicaid Fee-for-Service member will receive a professional dispensing fee rate increase from $10.38 to $10.50. Independent pharmacies, defined as those who own six or fewer pharmacies, who fill a prescription for a Medicaid managed care member will receive a professional dispensing fee rate increase from $10.38 to $10.50. 

Also in Nebraska, the Department of Health and Human Services published Provider Bulletin 25-09: Changes to the Nebraska Medicaid Preferred Drug List (PDL) effective July 18. 

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

2025-06-26T14:33:03-04:00June 26, 2025|Nebraska|

Nevada

Gov. Joe Lombardo (R) vetoed AB 259, legislation that would have set a fixed “maximum fair price” for drugs – a price dictated solely by a government standard – while excluding important costs such as the fees that pharmacies charge to dispense medications. Instead of imposing experimental price controls that could worsen drug shortages, NACDS and the coalition opposed to the bill recommended the administration focus on innovative solutions that lower drug costs without undermining access to essential medications or placing undue strain on our healthcare providers.

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

2025-06-26T14:32:28-04:00June 26, 2025|Nevada|

New Jersey

On June 19, the Assembly Committee on Financial Institutions and Insurance held another hearing on A4953. The Committee approved an amendment that would provide for a commercial rate floor, clarify the definition of network and non-network pharmacies and require fiduciary duties for PBMs. The bill remains in the committee.  

Also in New Jersey, on June 23, the Senate Committee on Commerce held a hearing on the "State of PBMs in New Jersey." NACDS submitted written testimony. Panels before the committee included those representing PBMs, pharmaceutical companies, health insurers and pharmacies. NACDS will continue to encourage the committee to take action to reform PBMs.  

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

2025-06-26T14:31:47-04:00June 26, 2025|New Jersey|
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