Michael Silber – Page 31

Florida

South Florida Community Care Network, LLC d/b/a Community Care Plan (Community Care Plan) currently provides behavioral health services. Beginning May 1, 2024, referrals, coordination and rendering of these services will also be provided by Ontrak Health. Members can receive behavioral health services from providers in Community Care Plan and Ontrak Health’s network. Community Care Plan is an SMMC (Statewide Medicaid Managed Care) plan operating in region 10.

For dates of service beginning May 1, 2024, Ontrak Health’s network providers should bill Ontrak Health for services rendered to Community Care Plan members. Community Care Plan’s network providers should continue to bill Community Care Plan for behavioral health services. Providers participating in both Community Care Plan and Ontrak Health’s network should use a unique Ontrak Health ID number when submitting their claims. Ontrak Health will be providing additional information for providers including the billing process.

Questions related to this transition may be directed as follows:

Community Care Plan Member Services: 1-866-899-4828
Community Care Plan Provider Services: 1-855-819-9506
Ontrak Health Provider Services: 1-855-840-3627

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

Michael Silber2024-04-04T10:37:58-04:00April 4, 2024|Florida|

Idaho

NACDS sent a letter to Gov. Brad Little (R) encouraging him to sign HB 596, legislation to further regulate PBMs (Pharmacy Benefit Manager) (Pharmacy Benefit Manager) in the state and, on April 1, the Governor signed the bill and issued this transmittal letter. The bill includes provisions that would prohibit the use of “spread pricing.” HB 596 also provides other vital reforms, including requiring 100% pass-through of manufacturer rebates to plan sponsors to keep patient premiums low, requiring that in-network pharmacies receive reasonable dispensing fees and implementing full disclosure and transparency requirements between the PBM (Pharmacy Benefit Manager) and the health plan, payor, and pharmacy.

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

Michael Silber2024-04-04T10:37:21-04:00April 4, 2024|Idaho|

Indiana

The Family and Social Services Administration’s Health Coverage Programs (IHCP) issued Bulletin BT202436 with pharmacy updates approved at the March meeting of the Drug Utilization Board.

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

Michael Silber2024-04-04T10:36:15-04:00April 4, 2024|Indiana|

Kansas

As a result of our past efforts finally recognizing Kansas pharmacists as Medicaid providers that can be reimbursed for services that are not directly related to the dispensing of medications, the Department of Health and Environment (KDHE) provided the new billing codes. KDHE established a new provider type for non-dispensing services, including immunizations, for pharmacies and pharmacists to enroll.

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

Michael Silber2024-04-04T10:35:44-04:00April 4, 2024|Kansas|

Louisiana

HB 579, legislation filed by Rep. Wayne McMahen (R) allowing pharmacists to screen patients, initiate therapy, administer and dispense PEP (Post Exposure Prophylaxis) and PrEP (Pre exposure Prophylaxis) medications, and receive payments at the same rate as other healthcare providers, was reported favorably from the House Health and Welfare Committee on April 3.

Also in Louisiana, HB 193, legislation filed by Rep. Chris Turner (R) that authorizes the transfer of a prescription or prescription information for controlled substances between pharmacies in conformance with federal regulations, unanimously passed the House on April 2 and was referred to the Senate.

Also in Louisiana, the next regular meeting of the PBM Monitoring Advisory Council on which NACDS has a designated Council seat is scheduled for April 11 and will be held in the Poydras Hearing Room (Ground Floor) at the Louisiana Department of Insurance. The meeting agenda includes instructions on how to participate in a Zoom meeting.

Finally in Louisiana, the Department of Health (LDH) issued Informational Bulletin 19-3, revising the options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCO) and the state’s fee-for-service claims processor, Gainwell Technologies. Unless explicitly notated, providers should first seek resolution with the MCO or Gainwell directly, prior to engaging LDH or other third parties.

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

Michael Silber2024-04-04T10:34:56-04:00April 4, 2024|Louisiana|

North Carolina

The Board of Pharmacy President Andy Bowman has announced that he will be leaving Board service before the end of his term, which opens a vacant position in the Board’s Southeastern District that will expire on April 30, 2026. To be eligible to run for this vacant Southeastern District seat, the candidate must be a pharmacist who holds an active North Carolina license to practice pharmacy and who resides (residential address, not work/practice address) in one of the counties comprising the Southeastern District. Interested pharmacists shall submit the following materials to the Board’s Executive Director, Jay Campbell, by 5:00 pm on April 26. For more information for the soon-to-be vacant Southeastern Board Member position, please visit the Board’s website.

a letter of interest and any written materials the pharmacist wishes the Board to consider; and
the signatures, legibly printed/typed names, and North Carolina pharmacist license numbers of ten (10) other pharmacists residing in the Southeastern District supporting the pharmacist’s candidacy.

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

Michael Silber2024-04-04T10:34:32-04:00April 4, 2024|North Carolina|

Maine

Gov. Janet Mills (D) ordered State Offices to be closed on April 4 due to anticipated weather conditions. The Pharmacy board meeting is cancelled. Unless otherwise decided, all matters on the Board’s agenda will be placed on the agenda for the next scheduled meeting on May 2.

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

Michael Silber2024-04-04T10:33:48-04:00April 4, 2024|Maine|

Massachusetts

MassHealth issued the following two updates on March 26:

Transmittal Letter ALL-246 – This letter transmits updates to 130 CMR 450.000: Administrative and Billing Regulations. Subsection 130 CMR 450.130 has been amended to reflect that MassHealth members will no longer be required to make copayments. Copayments have been temporarily eliminated since May 1, 2023; this update extends this policy indefinitely. These regulations are effective April 1, 2024.
Managed Care Entity Bulletin 112 – This bulletin relates to certain drugs that may be used for the treatment of obesity that a provider purchased through the 340B Drug Pricing Program (340B stock). The bulletin applies to Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), One Care Plans and Senior Care Organizations (SCOs) (collectively referred to as “Managed Care Entities”). In MCE Bulletin 109, the Executive Office of Health and Human Services (EOHHS) directed Managed Care Entities not to pay for specified GLP-1 agonist drugs if those drugs were purchased through the 340B Drug Pricing Program, effective April 1, 2024. Through this Bulletin, EOHHS is delaying the effective date of this policy until July 1, 2024.

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

Michael Silber2024-04-04T10:33:21-04:00April 4, 2024|Massachusetts|

New York

On March 27, the State Department of Secondary Education published the following emergency orders in the New York Register (March 27, 2024, Vol XLVI, Issue 13).

Pharmacist Dispensing Self-Administered Hormonal Contraceptives which was effective March 12, 2024, and
Administration of Injectable Medications by Pharmacists for the Treatment of Mental Health and Substance Use Disorder, effective April 1, 2024.

Also in New York, the State Department of Health also issued a billing guidance on issuance of hormonal contraceptives. For NYRx billing, see below:

To bill for the self-administered hormonal contraception, the pharmacy must submit a valid National Drug Code (NDC). Pharmacies must bill the Usual and Customary (U&C) price and will be reimbursed according to NYRx payment methodology and a $10.18 dispensing fee.
To bill for the evaluation and management associated with the ordering of self- administered hormonal contraception, pharmacies will submit using the National Council for Prescription Drug Programs (NCPDP) D.0 claim format and enter one of the Healthcare Common Procedure Coding System (HCPCS) codes identified below.
NYRx members may receive up to 12 months of prescription contraceptives at one time for family planning purposes as authorized by the Title 18 NYCRR Section 505.3(e).
Pharmacies are expected to dispense up to the quantity limit of the prescription or Standing Order, one year supply, at the time of dispensing, pursuant to patient preference or primary insurance coverage limitations.
Submitting any assessment code more than once a year requires cause.

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

Michael Silber2024-04-04T10:32:49-04:00April 4, 2024|New York|

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