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Vermont

Effective February 21, Change Healthcare started to experience network issues expected to continue throughout the weekend. To ensure Medicaid members receive necessary prescriptions and pharmacies have necessary guidance the agency offered the following:   

  • Claim Processing/Prescription and Emergency Fills: Claims are not processing currently. Existing federal law requires that a 72-hour emergency supply of a prescription drug be dispensed to Medicaid patients when the medication is needed without delay. Claims will be processed once the Change Healthcare system issues have been resolved. It is expected that providers will adhere to the provider agreements, which prohibit billing members when Medicaid will pay for services. Please refer to the provider manual for the limitations on billing members Vermont Medicaid Provider Manual (vtmedicaid.com). 
  • Eligibility: Eligibility must be verified through the automated Voice Response System (VRS), 800.925.1706, option 1 and then option 1 again or by utilizing online Transaction Services (https://vtmedicaid.com/#/home). For those members indicating new enrollment as of February 23, please call Maximus at 855-899-9600 during business hours and for afterhours please call the automated Voice Response System (VRS).  
  • Pharmacy Procedures: Many pharmacies have established internal procedures to handle such situations and we encourage dispensing medications to affected members to ensure continuity of care. 
  • Prior Authorizations: The outage is impacting the ability to issue prior authorizations. Therefore, prior authorization will be retroactively reviewed and applied for prescriptions filled during the system outage. Pharmacies must review the PDL to ensure the criteria is met prior to issuing new medications. Preferred Drug List (PDL) & Clinical Criteria | Department of Vermont Health Access 
  • Refills should be issued as requested based on the member’s history and clinical judgement. These claims will also be subject to a retroactive review. 
  • Controlled substance prescriptions: Please review the Vermont Prescription Monitoring System (VPMS) system as required.  
  • Helpdesk Access: Due to the outage, pharmacies are temporarily unable to contact the pharmacy helpdesk via phone or fax. Change Healthcare has indicated that the cause of the outage has been identified and they are working actively to restore normal operations. For questions, contact the Department of Vermont Health Access Pharmacy team at 802-879-5000 or ahs.dvhaph@vermont.gov.  

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

2024-03-01T10:06:52-05:00March 1, 2024|Vermont|

Washington

The PBM reform bill that passed the Senate earlier this month was amended in the House and continues to advance E2SSB 5213 through the legislative process despite the false claims that this bill would cost the state of Washington almost $239 million in excess drug spending in year one, and as high over $2.7 billion over the next 10 years. The bill is on the House calendar and must be voted out by 5:00 pm on March 1. If that occurs, the bill will be returned to the Senate for concurrence with amendments added in the House Health and Wellness Committee last week. 

Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) posted the agenda for the March 7 meeting. 

Also in Washington, register now for the Apple Health quarterly online seminar on March 7 aimed at providing HCA (Health Care Authority) partners with information about current Apple Health (Medicaid) programs and program updates. 

Also, in Washington, responsible pharmacy managers or equivalent managers of pharmaceutical firms must conduct an annual self-inspection in March and within 30 days of naming a new responsible pharmacy manager. The self-inspections are to be completed on Pharmacy Quality Assurance Commission provided worksheets. 

Finally in Washington, the Department of Health Prescription Monitoring Program is hosting a rulemaking workshop on March 19 to clarify the rules defining the concepts of “sold”, “dispense”, “filled” and “distributed”. 

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

2024-03-01T10:05:29-05:00March 1, 2024|Washington|

Wyoming

SF 0100 (Engrossed), legislation related to prompt payment of clean pharmacy claims, passed the Senate, and was introduced in the House and referred to the Corporations, Elections & Political Subdivisions Committee.  

 Also in Wyoming, Gov. Mark Gordon (R) sent the Senate his list of nominees for numerous state offices, boards, and commissions. These nominees are subject to confirmation by the Senate. Among the nominees are Summer Hanson, DVM. 

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

2024-03-01T10:04:45-05:00March 1, 2024|Wyoming|

Alabama

The Medicaid Agency created a new form titled “Notification of Request for Medical Records from Provider.” This form should be used by all Medicaid providers to notify Medicaid that recipients have requested copies of their medical records. For more information, click here.  

Also in Alabama, the Alabama Pharmacy Association is excited to announce the introduction of its podcast, “Off Script” hosted by Dr. Garrett Aikens. Through “Off Script”, they hope to provide important and timely updates about the ever-changing world of pharmacy. Go follow us on Spotify then listen to the intro and expect the first episode later this week as Louise and Danielle recap this week’s Board of Pharmacy meeting. 

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

2024-02-23T10:37:32-05:00February 23, 2024|Alabama|

Alaska

The broad PBM reform bill pharmacies are supporting, AK SSSB 121 was amended and referred to both the Senate Labor and Commerce and the Finance Committees for action.

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

2024-02-23T10:37:02-05:00February 23, 2024|Alaska|

Arizona

On February 21, the Senate Committee of the Whole (COW) adopted an amendment to SB 1085 (Senate Engrossed). The bill failed the third reading in the Senate on February 22.  Senate President Warren Petersen (R) offered a Motion to Reconsider.

Also in Arizona, SB 1021 (Senate Engrossed), repealing the Sunrise process for expansion of scope of practice for a “health professional group”, was adopted by the Senate with a vote of 24-4-2. 

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

2024-02-23T10:36:37-05:00February 23, 2024|Arizona|

Florida

The Agency for Health Care Administration (Agency), along with its fiscal agent Gainwell Technologies, has updated the NPI (National Provider Identifier) Mapping Logic that is used by the Florida Medicaid Management Information System (FL MMIS). Detailed information on the upcoming NPI Mapping Logic can be viewed on the NPI Initiative FAQ. The FAQ and additional information about the NPI Initiative can be obtained by visiting the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigating to Agency Initiatives, and selecting NPI Initiative. 

The NPI to Medicaid ID Search Engine was removed from the public Web Portal and is only available to those logged into their secure Web Portal. The enhanced tool is available by clicking the NPI to Medicaid ID Search Engine link under the Quick Links box within the secure Web Portal. 

The NPI to Medicaid ID Search Engine is accessible on the public Web Portal only for those applying and entering an NPI for full, limited or ROPA (Referring, Ordering, Prescribing and Attending) enrollment through the Online Enrollment Wizard. 

For more information, visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigate to Agency Initiatives, and select NPI Initiative. 

For information on how to perform a password reset for a secure Web Portal user account that is locked, refer to the Secure Web Portal Account Maintenance Quick Reference Guide (QRG) 

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

2024-02-23T10:35:28-05:00February 23, 2024|Florida|

Hawaii

HB 2553, legislation expanding pharmacists immunization authority for minors, passed its first two committees. 

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

2024-02-23T10:34:49-05:00February 23, 2024|Hawaii|

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