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So far Michael Silber has created 1944 blog entries.

Pennsylvania

Medicaid plans to implement a system to reimburse pharmacies for a variety of services within their current scope of practice in 2024. We understand these would include immunizations, counseling, and diabetes management; and would apply to both the Fee-For- Service and Managed Care Program. We understand a Bulletin announcing the new program will be released the first week of December. NACDS will provide updates as we receive them, including instructions on enrollment. NACDS has been supporting member and in-state efforts to develop the program.

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

2023-11-03T11:42:10-04:00November 3, 2023|Pennsylvania|

Rhode Island

Please see the November 2023 provider update. Previous updates can also be found on the Executive Officer of Health and Human Services (EOHHS) Provider Updates web page.  

Also in Rhode Island, Medicaid has noticed an increase in the number of Continuous Glucose Monitors (CGMs) submitted via pharmacy claims. Please note that Medicaid considers CGMs as DME products and requires prior authorization for all CGM-related items. All prior authorization requests must be submitted by the dispensing provider and must include a prescription and recent clinical notes. Requests submitted directly by ordering physicians will be returned. 

In adherence with recent Medicare HCPCS code updates, Medicaid activated the following CGM codes: 

  • A4239 – SUPPLY ALLOWANCE FOR NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE 
  • E2103 – NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR OR RECEIVER  

Effective October 1, 2023, prior authorization requests submitted under codes K0553 and/or K0554 are being returned and must be resubmitted with the proper codes. 

Claim submission for reimbursement must be done using either the 837 professional file format or via the CMS 1500 paper claim. Claims submitted otherwise will be denied. 

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

2023-11-03T11:41:43-04:00November 3, 2023|Rhode Island|

South Carolina

The City of Columbia is launching a pilot program to address food deserts through subsidized delivery of groceries in certain parts of the city to eligible residents. The pilot is limited to Instacart delivery service and those retailers who operate on that platform; however, the goal of the city is to expand the program after the pilot to include more retailers and delivery services. For more information on the program, click here.  

Also in South Carolina, the Department of Health and Human Services will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments to accommodate the November 2023 state holiday schedule. Due to observance of the Thanksgiving holiday, November 17 at 5:00 pm is the deadline to submit claims for payment date November 24. Payments will run November 20 and electronic remittance advice will be available November 21. Payments will be dated November 24, as usual. The schedule will return to the normal payment cycle on the payment date December 1.

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

2023-11-03T11:40:31-04:00November 3, 2023|South Carolina|

Tennessee

Effective November 1, BD is the sole preferred manufacturer of insulin syringes and pen needles. Please refer to the OTC list for a list of covered NDCs. The updated OTC list, including covered NDCs, was posted to the Optum Rx TennCare website on November 1, 2023. Please refer to the November Provider Notice and contact TNRxEducation@optum.com with any questions. 

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

2023-11-03T11:39:57-04:00November 3, 2023|Tennessee|

California

The Board of Pharmacy posted the agenda and meeting materials for its November 1-2 Board Meeting. Please note the committee reports, particularly Enforcement & Compounding with respect to legislation recently signed by Gov. Gavin Newsom (D) and the Licensing Committee meeting items, e.g., remote processing, ratio, CLIA-waived tests, and central fill pharmacies. 

Also in California, the Department of Health Care Services (DHCS) posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal. Please note the alert about the quantity limit restrictions for certain continuous glucose monitoring devices. 

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

2023-10-27T12:02:19-04:00October 27, 2023|California|

Georgia

The House Rural Development Council, chaired by Rep. Gerald Greene (R), met this week, and heard comments from Michael Power, the Senior Director for State Government Affairs at the Pharmaceutical Care Management Association on PBMs (Pharmacy Benefit Managers) and their role in drug spending. A recording of the meeting has been posted online.  

Also in Georgia, the Board of Pharmacy has voted to initiate a public comment period for proposed changes to the Remote Prescription Drug Order Processing Rules (Rule 480-36-.01 and Rule 480-36-.07). The changes posted for public comment include the following. These changes will undergo a 30-day public comment period and are expected to be officially approved by the Board in December 

  • Removing Rule 480-36-.07: This removes the requirement for notifying patients when utilizing remote prescription drug order processing. 
  • Modifying Rule 480-36-.01: The final sentence that restricted the number of secondary remote entry pharmacists assisting the primary dispensing pharmacy has been struck. 

  Finally in Georgia, the Board of Pharmacy has provided clarification regarding the administration of the RSV (Respiratory Syncytial Virus) vaccine. They have confirmed that it can be administered in accordance with the statute, as it is now included in the recent update of the adult immunization schedule appendix.  

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

2023-10-27T12:01:51-04:00October 27, 2023|Georgia|

Illinois

The Department of Healthcare and Family Services is currently offering several new behavioral health courses through its Provider Assistance and Training Hub (PATH). All courses are open for registration in the Medicaid Technical Assistance Center (MTAC) Learning Center. Create or sign into your MTAC account at https://go.uillinois.edu/MTAC to access all available training courses. For training questions, please contact PATH-BH@illinois.edu. For questions about the MTAC Learning Management system, please reach out to omi.training@uillinois.edu. 

Also in Illinois, the Illinois Legislative Black Caucus Foundation (ILBCF) is looking to host a statewide Veteran’s Day Event November 10-12. Its goal is to give away 1,500-2,000 bags of groceries to Black Veterans throughout the state. To date, they have secured a donation of 500 bags of groceries and are trying to secure 1,000-1,500 additional. They say gift cards would be helpful as well. The groceries would be distributed throughout the state but particularly East St. Louis, Peoria, Champaign, Chicago (south and west sides) and the south suburbs of Chicago/Will County. If you are interested in supporting this event, please contact Tiffany Hightower, the Executive Director of the ILBCF at executivedirector@ilbcf.org or 773-896-6805.  

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

2023-10-27T12:01:13-04:00October 27, 2023|Illinois|

Massachusetts

On October 26, the Senate unanimously passed SB (Senate Bill) 2480 which will authorize pharmacists to prescribe, dispense and administer HIV (Human Immunodeficiency Virus) prevention drugs according to Department of Public Health and FDA (Food & Drug Administration) regulations and guidelines. The patient must prove they are HIV negative. The pharmacists may order an HIV test prior to prescribing and dispensing if the patient cannot provide proof of a negative HIV test. The pharmacist shall notify the patient that they will be required to be seen by a primary care provider to receive subsequent prescriptions for pre-exposure prophylaxis. A pharmacist shall not furnish a 60-day supply of pre-exposure prophylaxis to a single patient more than once every two years. The pharmacist shall notify the patient’s primary care provider following the dispensing of the drug and provide the patient with a list of local providers if the patient is not under the care of a provider. This bill will now be referred to the House of Representative for its consideration. As was the case last session, this bill will be referred to the Joint Committee on Health Care Financing from where it can be considered as a stand-alone bill or as part of the debate on a comprehensive healthcare reform bill which we expect to begin in the Senate soon. 

The Massachusetts Board of Pharmacy posted it’s agenda for the November 2 meeting. Three policies are on the agenda as follows:  

  • Policy 14-02: Board Delegated Review (BDR): The “unknown loss protocol” was removed from the policy since the Board voted for a new “controlled substance loss protocol” at the October meeting. Also added was the ability for BDR to issue a reprimand for the loss of less than #100 units of a Schedule II controlled substance.  
  • Policy 2021-04: Continuing Education (CE) Requirements for Pharmacists: Details for the required pain management training for collaborative drug therapy management (CDTM) pharmacists were added to the CE policy. With this addition, we request that the advisory titled “Pain Management Training for CDTM Pharmacists” be rescinded.  
  • Policy 2023-01: Compliance Packaging and Reusable Dose Planners: The change to this policy allows Schedule II and III maintenance medications to be placed in multidrug-single-dose compliance packages. 

MassHealth posted its October monthly bulletin that announced the start dates for enforcing the ordering, referring, and prescribing (ORP) requirements. Except the information in this bulletin, all information in APB 361 and APB 376 remains in effect. Due to necessary system updates, the start date to enforce the requirement that claims processed by the Pharmacy Online Processing System (POPS) must include a prescriber who is actively enrolled with MassHealth will be delayed. This requirement will be enforced for service dates on or after May 1, 2024. Pharmacies should continue reviewing informational messages related to this requirement to avoid ORP-related denials when enforcement takes effect. 

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

2023-10-27T12:00:07-04:00October 27, 2023|Massachusetts|

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