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Illinois

The Department of Healthcare and Family Services (HFS) has issued a Provider Notice regarding Respiratory Syncytial Virus (RSV) vaccines for Medicaid customers. Additional information on other Provider Notices regarding these vaccines are available online.  

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for Medicaid Fee-for-Service claims, or the appropriate Medicaid Managed Care program. 

Also in Illinois, the Department of Healthcare and Family Services (HFS) continues to prepare for the release of the new over-the-counter (OTC) birth control pill, Opill, which is anticipated in early 2024. Opill will be covered by HFS under both the Medicaid Fee-for-Service (FFS) and Managed Care programs without a prescription for women aged 18 years and older. 

HFS requires pharmacies to submit all claims, including those for OTC medications, with a prescriber National Provider Identifier (NPI) in the Prescriber ID field (411-DB). For Opill, pharmacies may bill using the Department of Public Health standing order prescriber NPI for hormonal contraceptives.    

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate Medicaid Managed Care program. 

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

2024-01-12T11:59:54-05:00January 12, 2024|Illinois|

Indiana

The legislature convened its 60-day short session on January 8. 

Also in Indiana, the state Health Coverage programs (IHCP) issued two bulletins of interest to pharmacies: 

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

2024-01-12T11:59:10-05:00January 12, 2024|Indiana|

Iowa

The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2543-MC-FFS: Amerigroup Iowa, Inc. Rebranding to Wellpoint Iowa, Inc. 

Also in Iowa, on January 3, 2024, Wellpoint released Clinical UM Guideline (Guideline #CG-DME-42) regarding the use of continuous glucose monitoring devices (CGMs). Also review the Iowa Administrative Code and Department of Human Services Medical Equipment and Supply Dealer Provider Manual for related information; see pages 39-40. Please contact the following for assistance: Angela Dillon or Joely Anderson. 

Also in Iowa, in response to complaints by Iowa pharmacies, Andria Seip, Senior Health Policy Specialist, Iowa Insurance Division, sent a memo on January 4, 2024, to PBMs (Pharmacy Benefit Managers) licensed in the state that contracts requiring reimbursement models using “effective rates” are considered prohibited under Iowa Code section 510B.8C.  

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

2024-01-12T11:58:17-05:00January 12, 2024|Iowa|

Kentucky

The Medicaid Advisory Committee approved several motions suggested by the Pharmacy Technical Advisory Committee (PTAC), that NACDS serves on, to improve access to pharmacy vaccines in the Medicaid program: 

  • A written communication will be delivered to pharmacies clarifying that, per the rule passed last year, enrollment in VFC (Vaccines for Children) program is not required and claims will be reimbursed. 
  • They will work with PTAC to change policy to allow pharmacies to bill for vaccines in Medicaid FFS (Fee-for-Service).  
  • They will work with PTAC on a statewide protocol for pharmacists to administer HPV (HUMAN PAPILLOMA VIRUS) vaccines to increase adolescent vaccination rates. 

Members are encouraged to share their thoughts and suggestions on these proposed policy changes with NACDS’ Jill McCormack.  

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

2024-01-12T11:56:35-05:00January 12, 2024|Kentucky|

Louisiana

On January 7, Gov. Jeff Landry (R) was sworn into office, replacing former Gov. John Bel Edwards (D), who had reached his term limit. Ralph Abraham, MD, a physician, was appointed head of the Louisiana Department of Health. NACDS and our in-state partner, the Louisiana Alliance for Retail Pharmacies (LARP), have requested a meeting. 

Also in Louisiana, the new Legislature elected last Fall was sworn in on January 8. Currently, Republicans hold a supermajority in both Houses. 

Also in Louisiana, NACDS’ in-state partner, the Louisiana Alliance of Retail Pharmacies (LARP), submitted a comment letter to the Board of Pharmacy at the December 28, 2023, public hearing raising concerns about a proposed rule on product integrity that implements temperature control measures for shipments of prescription drugs to patients. Specifically, the proposed rule change would require ALL home delivery medications, including room temperature medications, to be sent in temperature-controlled packaging from pharmacies to patients.  

Also in Louisiana, the Department of Health (LDH) issued an Informational Bulletin 23-22 to Medicaid providers reminding them that RSV vaccines that have been covered since August 3, 2023, must have the correct CPT codes 90380 and 90381.  

Finally in Louisiana, in late December 2023, the Centers for Medicare & Medicaid Services (CMS) approved the state plan amendment (SPA) to increase the dispensing fee for local pharmacies only from $10.99 to $11.81. The increased fee applies to Medicaid Fee-for-Service pharmacy claims and Medicaid Managed Care local pharmacy claims, retroactive to the date of service of October 1, 2023. 

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

2024-01-12T11:55:53-05:00January 12, 2024|Louisiana|

Maine

On January 4, the Maine Board of Pharmacy held its regular meeting. The agenda included the following: 

  • Access to HIV Prevention Medications (PL 2021 Ch 265), including PEP and PrEP Protocols 
  • Access to Birth Control by Making Certain Contraception Accessible from a Pharmacist (PL 2023 Ch 115)  
  • Authorize Vaccine Administration by Pharmacy Technicians and Reduce Vaccine Administration Training Requirements for Pharmacists (PL 2023 Ch 245)  
  • Board Rule Chapter Amend Limits on Medication in Vending Machines (PL 2023 Ch 160)  
  • Pharmacists Dispense an Emergency Supply of Chronic Maintenance Drugs (PL 2023 Ch 566) – Update  
  • Telehealth Rulemaking Status – Update  

Also in Maine, on January 11, Gov. Janet Mills (D) issued a State of Emergency declaration. The State of the Civil Emergency will last one week, and the Governor will continue to evaluate its necessity daily. This declaration triggers the hazard pay provision for the City of Portland for those with operations within the city. 

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

2024-01-12T11:55:04-05:00January 12, 2024|Maine|

Maryland

The Board of Pharmacy final rule, COMAR 10.34.34, permitting Technician Product Verification (TPV) has been published and will be effective on January 28, 2024. You can find more details in the latest Board of Pharmacy newsletter. The rule allows TPV in both community and institution-based pharmacies. 

Also in Maryland, the Department of Health announced that, in accordance with Senate Bill 678/House Bill 1151, they will permit Medicaid-enrolled pharmacist providers to bill Maryland Medicaid for professional services rendered within their lawful scope of practice, effective January 1, 2024. They released guidance for MTM (Medication Therapy Management) and Tobacco Cessation services on transmittal # PT 29-24 and transmittal # PT 49-24. Medicaid-enrolled pharmacists can bill Maryland Medicaid using billing and coding information according to the CMS 1500 Billing Instructions (Revised September 2023). For other ordinary questions, please email mdh.pharmacistsprofservices@maryland.gov or visit Pharmacists Professional Services.  

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

2024-01-12T11:54:19-05:00January 12, 2024|Maryland|

Massachusetts

The Board of Pharmacy issued the following updates on January 11.  

  • Emergency Contraceptive (EC) Dispensing Report: Any EC dispensed pursuant to the standing order within a calendar year (January 1 – December 31) must be reported using the Annual Emergency Contraception Standing Order Report.  
  • Policy 2024-01 Naloxone Dispensing: Reviews the dispensing of over-the-counter (OTC) naloxone. 
  • Policy 2019-02 Automated Dispensing Device Use: Information for Hospice Inpatient Facility acute use was added.  
  • Policy 2018-01 Permitted Prescription Changes and Additions: Flavoring agent information was added. 
  • 247 CMR 22.00: Monetary Penalties: Draft Regulation.  

The Board also sent a reminder to community pharmacies that the Board regulations require all community pharmacies to provide non-sterile compounding services to their customers. It has come to the Board’s attention that some pharmacies have discontinued their non-sterile compounding services. The Board cited the two regulations below that require this practice to be available; see below. The Board urged any pharmacy that has any questions about these regulations to contact them. The Board is discussing the need for further Board guidance on this issue, which they expect to discuss at a future meeting. 

  • 247 CMR 6.02: Conditions for Continuing Registration and Operation of a Pharmacy or Pharmacy Department 
    • (4) The pharmacy or pharmacy department shall maintain on the premises at all times a sufficient variety and supply of medicinal chemicals and preparations which are necessary to compound and dispense commonly prescribed medications in accordance with the usual needs of the community. 
  • 247 CMR 9.01: Code of Professional Conduct for Registered Pharmacists, Pharmacies and Pharmacy Departments 
    • (16) A pharmacist shall not refuse to compound customary pharmaceutical preparations except upon extenuating circumstances.

Also in Massachusetts, on January 10, the Public Health Council voted to make permanent the current emergency regulations at 105 CMR 700.004 (15) that authorize pharmacists to prescribe and dispense certain hormonal contraceptives. The Department of Public Health and the Council did not make any changes to the original emergency regulations. As a result, there will be no change to the current practice in this area.

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

2024-01-12T11:53:48-05:00January 12, 2024|Massachusetts|

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