Michael Silber – Page 78

New Jersey

On July 10, Gov. Phil Murphy (D) signed a package of bills targeting prescription drug costs. Most relevant was A536, an Act Concerning Pharmacy Benefit Managers (PBMs). This new law establishes greater oversight of PBMs. The act requires rebates to be used to lower premiums and out-of-pocket costs for consumers and prevents the practice of spread pricing. It also requires PBMs to apply for a license from the NJ Department of Banking & Insurance to strengthen regulatory oversight.

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

Michael Silber2023-07-21T10:46:42-04:00July 21, 2023|New Jersey|

New York

On July 17, the State Department of Financial Services adopted an amendment to the final rule regarding the PBM regulations and entities filing by electronic submissions.

On July 13, the State Department of Health’s NYRx, the Medicaid Pharmacy Benefit Program, posted a program update for providers and prescribers. On July 14, they also announced prior authorization program updates.

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

Michael Silber2023-07-21T10:46:10-04:00July 21, 2023|New York|

Ohio

The Board of Pharmacy published the agenda for the August 22 public hearing.

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

Michael Silber2023-07-21T10:45:33-04:00July 21, 2023|Ohio|

Oklahoma

The Board of Pharmacy’s COVID-19 Waiver Request form that helped pharmacies navigate through challenging times during the pandemic has been changed to a “Waiver Request” form.

Also in Oklahoma, the Bureau of Narcotics and Dangerous Drugs Control passed a law defining “Acceptable IDs for CDS Prescriptions,” changing the definition of recipient’s identification number and recipient’s agent’s identification number for acceptable forms of identification for obtaining a controlled dangerous substance (CDS) prescription. The definition now refers to a federal law, which is 8 Code of Federal Regulations (CFR) 274a.2(b) (1)(v)(A) and (B). Title 63 O.S. §2-309B. 7. “Recipient’s identification number” and “recipient’s agent’s identification number” means the unique number contained on forms of identification listed in 8 CFR 274a.2(b) (1)(v)(A) and (B).

Also in Oklahoma, the Attorney General is staffing up in preparation to taking over enforcement of PBM laws.

Finally in Oklahoma, the Board of Pharmacy held a hearing on July 19.

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

Michael Silber2023-07-21T10:44:53-04:00July 21, 2023|Oklahoma|

Oregon

Gov. Tina Kotek (D) signed SB 608, requiring the Oregon Health Authority (Medicaid) to conduct a cost of dispensing study every three years and the first study is due January 2, 2024.

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

Michael Silber2023-07-21T10:44:18-04:00July 21, 2023|Oregon|

Rhode Island

Medicaid is preparing to implement the Real Time 270/271 Eligibility Verification Request and Response and Real Time 276/277 Claim Status Request and Response Transactions. For Real Time transactions, the sender remains connected while the receiver processes the transactions and returns a response to the sender and with an average response time within 20 seconds. Gainwell will utilize a Real Time Safe Harbor interface referred to as HDE (Health Direct EDI). This will allow for trading partners to transmit the Real Time transactions directly to the translator (EDIaaS).

HDE connectivity and requirements per CAQH Core Rules

Trading Partner Software web service to process transaction
Trading Partner transaction can be in SoapUI or MIME format for submission
Trading Partner will receive a URL, HDE username and password to access the HDE connection.

What does this mean? If you are a provider, contact your software vendor, clearing house or billing agency. Medicaid does not offer software for these Real Time transactions.

To participate

Do you have a trading partner number?
Is your contact information on the Healthcare Portal current?
If you have answered yes to the above questions and are interested in these Real Time transactions, please answer the questions below.

Testing will begin late July to mid-August.

To participate in testing, you must provide the information below.

Name, TPID, contact name, email, and telephone number. Identify format (SOAPUI or MIME) for submitting Real Time transactions.

Send your answers to riediservices@gainwelltechnologies.com. Please make sure to add a subject line of Real Time Transactions.

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

Michael Silber2023-07-21T10:43:46-04:00July 21, 2023|Rhode Island|

South Carolina

The Department of Health and Human Services (SCDHHS) consistently offers free training to prospective and enrolled Healthy Connections Medicaid providers. Many of these courses are available virtually. Information about the upcoming Healthy Connections Medicaid eLearning trainings for summer 2023 is listed here. These recurring virtual workshops cover a variety of topics including training on Medicaid basics, how to submit claims using the web-based tool and third-party liability (TPL). To register for a workshop, please visit the Medicaid eLearning site, www.medicaidelearning.com, or call (888) 289-0709 and select option 1. Additional training resources for providers are also available online through the Medicaid eLearning site.

Also in South Carolina, on July 18, 2023, CVS Pharmacy reached out to the Medical University of South Carolina to authenticate a hardcopy prescription for Promethazine DM (in a 473 ml bottle) and Tessalon Perles. The medical provider listed on the prescription was Dr. Chitra Lal. During the verification process, concerns were raised regarding the signature on the prescription. It was observed that the signature was not a conventional ‘wet’ signature and appeared to deviate from Dr. Lal’s usual signature style. This discrepancy prompted a deeper investigation into the matter. Upon further examination, it was established that the prescription in question was a forgery. Rx verification should be requested by calling 864.255.5638.

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

Michael Silber2023-07-21T10:42:57-04:00July 21, 2023|South Carolina|

Tennessee

The new rule from Tennessee Department of Commerce and Insurance, 0780-01-95 – Pharmacy Benefits Managers, became effective June 27, 2023.

Also in Tennessee, beginning August 1, 2023, prior authorization requirements will be removed for the following preferred medications: Advair Diskus, Advair HFA, Dulera, Symbicort, aripiprazole, Diclegis, ezetimibe, fenofibrate and Xarelto. We encourage you to read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) should you have additional questions.

Finally, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL [Preferred Drug List] may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. We encourage you to read this notice thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) or tnrxeducation@optum.com should you have additional questions. For more details on Clinical Criteria, please visit https://www.optumrx.com/oe_tenncare/landing.

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

Michael Silber2023-07-21T10:42:11-04:00July 21, 2023|Tennessee|

Texas

The 88th Regular Legislative Session adjourned sine die May 29. Gov. Greg Abbott (R) immediately called the first 30-day special session to address property tax cuts, which ended with no bills advancing to the Governor’s desk. The Governor called a second special session to address property tax cuts. Speaker Dade Phelan (R) and Lt. Gov. Dan Patrick (R) finally reached an agreement on a property tax relief package, it passed and was signed by the Governor.

Also in Texas, Gov. Abbott signed into law several bills of interest to pharmacies:

SB 2173 creates a voluntary prescription drug safe disposal pilot program to be developed by the Board of Pharmacy;
HB 1283, legislation that makes permanent the single statewide drug formulary and preferred drug list for Medicaid managed care organizations; and
HB 999, the copay accumulator bill requiring health plans and PBMs, not pharmacies, to apply any coupon or other reduction in out-of-pocket expenses made by or on behalf of an enrollee to the enrollee’s deductible copayment, cost sharing responsibility or out-of-pocket maximum applicable to prescription drug benefits.

Also in Texas, with Attorney General Ken Paxton (R) still suspended from office as he awaits his September impeachment trial in the Senate, Gov. Abbott appointed Angela Colmenero as the new Interim Attorney General, replacing the short-term Interim Attorney General John Scott.

Also in Texas, Vaccines for Children (TVFC) Program provider manual is now on-line. TVFC IQIP providers are responsible for understanding program policies and requirements for 2022-2023 TVFC re-enrollment. The 2023-2024 Texas Vaccines for Children (TVFC)/Adult Safety Net (ASN) Program re-enrollment will open in October 2023 and close November 2023.

Finally in Texas, the agenda for the Drug Utilization Board July 21 meeting was posted.

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

Michael Silber2023-07-21T10:41:31-04:00July 21, 2023|Texas|

About Michael Silber