Michael Silber, Author at In The States

Oregon

Gov. Tina Kotek (D) signed HB 4149, PBM legislation that requires pharmacy benefit managers to be licensed by the Department of Consumer and Business Services beginning January 1, 2025; modifies the definition of “pharmacy benefit manager” and imposes new requirements on PBMs (Pharmacy Benefit Managers); restricts audits of pharmacy claims for reimbursement; requires PBMs to report specified information to the department on an annual basis; and imposes new requirements with respect to the insurance coverage of 340B drugs.

Also in Oregon, Gov. Tina Kotek (D) signed HB 4002, legislation permitting pharmacist dispensing of opioid use disorder medication refills and requires health insurers and community care organizations (CCOs) to reimburse the cost of refills of substance use disorder medications.

Finally in Oregon, the Prescription Drug Affordability Board posted the draft agenda and meeting materials for its next meeting on April 17. Please register in advance of the meeting.

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

Michael Silber2024-04-11T14:36:01-04:00April 11, 2024|Oregon|

Pennsylvania

HB 1993, a companion bill to SB 1000, a comprehensive commercial and Medicaid PBM reform bill has been introduced by Rep. Jessica Benhem (D). Both bills have strong bi-partisan co-sponsorship and support. NACDS continues to work collaboratively with the Pennsylvania Association of Chain Drug Stores and the Pennsylvania Pharmacy Coalition and legislators to advance these bills.

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

Michael Silber2024-04-11T14:35:18-04:00April 11, 2024|Pennsylvania|

Tennessee

The Department of Commerce and Insurance (TDCI) shared a rule filing regarding PBMs. The TDCI regulations on audits of PBMs were approved and will take effect on June 26, 2024.

Also in Tennessee, congratulations to Dean Bill Gentry of South College School of Pharmacy, who announced his upcoming retirement effective July 2, 2024.

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

Michael Silber2024-04-11T14:34:37-04:00April 11, 2024|Tennessee|

Texas

The Texas Pharmaceutical Initiative (TPI) three-member Board held a hybrid meeting on April 9. Five of the largest state agencies on the Advisory Council (TIPAC) provided testimony, addressing issues such as prescription drug pricing, the potential for savings with a single PBM, specialty pharmacies drug pricing, the most expensive prescription drugs prescribed, drug shortages and rebates. HB 4990 passed during the 2023 Regular session requires TPI to present a plan for the legislature by October 1, 2024. The Board also has the authority to explore a distribution network and partnerships to launch a manufacturing facility for generic or biosimilar drugs. The Health and Human Services Commission (HHSC) recommended that the prescription drug importation program law aimed at providing lower cost prescriptions by importing them through Canada (HB 25-2023), also be addressed by TPI.

Also in Texas, the Gainwell point-of-sale claims system, the VDP (Vendor Drug Program) Provider Portal and the VDP eCOI (Electronic Certification of Information) Portal are now active.

Finally in Texas, the Board of Pharmacy posted proposed rules for prescription drug deliveries and non-sterile compounding in the March 22 Texas Register (see pages 1852-1863). Written comments on the proposed rules may be submitted to Eamon D. Briggs, Deputy General Counsel, Texas State Board of Pharmacy, 1801 Congress Avenue, Suite 13.100, Austin, Texas 78701-1319, FAX (512) 305-8061. Comments must be received by 5:00 pm on April 30, 2024.

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

Michael Silber2024-04-11T14:33:53-04:00April 11, 2024|Texas|

Virginia

Gov. Glenn Youngkin (R) vetoed companion bills (HB 570 / SB 274) that would have created a Prescription Drug Affordability Board (PDAB) in the state. This move comes as three other states actively conduct affordability reviews of prescription drugs nationwide. NACDS will be monitoring the final outcome of the bill when the Legislature returns later this spring for its veto session. NACDS joined other organizations in expressing opposition to the bill to Gov. Youngkin.

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

Michael Silber2024-04-11T14:32:49-04:00April 11, 2024|Virginia|

Washington

NACDS applauds the enactment of ESSB 5213, a new law signed by Gov. Jay Inslee (D) on March 25 that will hold PBMs accountable. Although the law exempts the Employment Retirement and Security Act (ERISA) plans, it enhances the Insurance Commissioner’s enforcement authority, establishes an appeals process, opens the network, includes anti-steering and mail order provisions, prohibits spread pricing and expands Maximum Allowable Cost appeals to all prescriptions, not just generic drugs. The bill sponsor, Sen. Patty Kurderer (D), who is running for the office of Insurance Commissioner in November, plans to enforce this new law and actively seek further PBM reforms, if elected.

Also in Washington, the Heath Care Authority asked NACDS to alert pharmacies that recently they have seen delays from its switch vendors and/or software vendors in applying changes for testing. Sarah Stewart said these changes to the BIN number and other information on the payer sheet for its POS (point of sale) replacement system are going live on April 27, 2024.

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

Michael Silber2024-04-11T14:32:16-04:00April 11, 2024|Washington|

Alaska

The Centers for Medicare & Medicaid Services (CMS) approved an extension effective March 26, 2024, through December 31, 2028, for a 1115 “Behavioral Health Reform” demonstration project. This approval continues the state’s existing authority to receive federal financial participation (FFP) for providing clinically appropriate substance use disorder (SUD) treatment services for short-term residents in residential and inpatient treatment settings that qualify as an institution for mental diseases (IMD), as well as provides additional services to enhance the comprehensive and integrated behavioral health system for children, youth and adults with serious mental illness (SMI), severe emotional disturbance (SED) and/or SUDs (Substance Use Disorders).

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

Michael Silber2024-04-04T10:45:38-04:00April 4, 2024|Alaska|

Arizona

On March 29, Gov. Katie Hobbs (D) signed SB 1165 (Chapter 51), legislation outlining specified provisions an auditing entity must comply with when conducting a wholesale invoice audit and prohibits an auditing entity from retroactively reducing the amount of a claim unless specified criteria apply.

Also in Arizona, on April 2, Gov. Katie Hobbs (D) signed SB 1021, legislation removing the requirement that health professional groups proposing to increase the scope of practice of a state-regulated health profession must complete a statutory sunrise review.

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

Michael Silber2024-05-08T17:14:10-04:00April 4, 2024|Arizona|

Arkansas

The Insurance Commissioner issued Directive 1-2024 suspending for 60 days the technical filing requirements, audits and recoupments related to claims for providers impacted by the Change Healthcare data breach.

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

Michael Silber2024-04-04T10:42:22-04:00April 4, 2024|Arkansas|

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