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So far Michael Silber has created 2507 blog entries.

Alabama

Medicaid issued an Alert announcing, effective October 1, Continuous Glucose Monitors (CGMs) were covered through the Durable Medical Equipment (DME) Program with prior authorization (PA) for recipients (children and adults) with one of the following: 

  • type 1 diabetes mellitus 
  • type 2 diabetes mellitus and are insulin treated with multiple (three or more) daily injections of insulin 

 

NOTE: CGMs are not covered through the pharmacy benefit; requests must be submitted by a DME-enrolled provider with an active National Provider Identifier (NPI). 

Also in Alabama, the Board of Pharmacy technician registrations expire December 31. The Board is accepting pharmacy technician renewals online at www.albop.com. Please don't wait until the last minute to renew.  

Important information for technicians and their employers: If you are completing the Alabama Pharmacy Association (APA) Pharmacy Technician Training or employing a technician completing the program, please take note. With the upcoming holidays, please be aware of the following important dates and plan accordingly. 

The APA office will be closed on Christmas Eve through January 1, 2026. If you complete the program after December 22, you may not receive a certificate of completion until January 5, 2026. If you need to complete the training before you renew your license, please do so before December 22. 

APA will email certificates of completion on the following dates in December: 

  • Monday, December 1 
  • Monday, December 8 
  • Monday, December 15 
  • Monday, December 22 

 

Please contact the APA office if you have any questions. 

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

2025-11-20T10:07:02-05:00November 20, 2025|Alabama|

Alaska

The Board of Pharmacy posted the meeting materials for its quarterly teleconference meeting held on November 20. Included on the agenda were updates from industry on pending pharmacist prescriptive authority legislation, SB 147 and HB 195.

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

2025-11-20T10:06:22-05:00November 20, 2025|Alaska|

California

The Department of Health Care Service posted the following on the Medi-Cal Rx Web Portal. Please note the update on GLP-1 coverage effective January 1, 2026; see details below in the alert. 

Also in California, as part of the Board's actions during the November 5-6 Board Meeting, the Board approved a policy statement related to the transition to a Standard of Care Practice Model for some pharmacist-provided health care services. Specifically, under provisions of Assembly Bill (AB) 1503 (Berman, Chapter 196, Statutes of 2025), certain pharmacist-provided patient care services are transitioning to a standard of care practice model. 

Finally in California, the Board of Pharmacy approved a policy statement related to the role of the Pharmacist-in-Charge (PIC). Specifically, under AB 1503, new provisions reinforce the decision-making autonomy of the PIC related to staffing decisions. 

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

2025-11-20T10:05:04-05:00November 20, 2025|California|

Colorado

Facing a $850M budget deficit, Gov. Jaris Polis (D) proposed cuts to the Medicaid professional dispensing fee (PDF) for pharmacies. For fiscal year 2025-2026, the Health Care Financing and Policy (HCFP) will cut the tiered fee by $85,000 and propose a $506,000 reduction for 2026-2027. Reimbursements for high-volume pharmacies will drop from $10.25 to $9.93 and from $9.31 to $8.72. 

Also in Colorado, a Rural Health Transformation Program Webinar for all stakeholders will be held from 10:00 am – 11:30 am Mountain Time on December 2. 

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

2025-11-20T10:04:31-05:00November 20, 2025|Colorado|

Illinois

The purpose of this Provider Notice is to inform pharmacy providers that the claims adjudication system is now able to process and pay compound claims. The processing system had been paying compound claims at zero since the Change Healthcare outage in March 2024.  

At this time, pharmacy providers are encouraged to void and rebill those claims that were either paid at zero or held pending restoration. This applies to fee-for-service (FFS) billing only.  

Please call the Bureau of Professional and Ancillary Services at 877-782-5565 and speak to a pharmacy consultant to obtain any necessary overrides on rejections that may occur while rebilling these claims.

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

2025-11-20T10:03:59-05:00November 20, 2025|Illinois|

Iowa

The Department of Health and Human Services (HHS), Medicaid posted the following. Please note effective December 1, the optional 90-day supply allowance will now be a required 90-day supply prescription list. The list of medications for this requirement is posted on the PDL website; see letter below for details. 

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

2025-11-20T10:03:26-05:00November 20, 2025|Iowa|

Louisiana

The Department of Health (LDH) announced a webinar on December 4 from 10:00 am to 11:00 am Central Time. This event aims to inform stakeholders about LDH’s Rural Health Transformation Program (RHTP) submission.

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

2025-11-20T10:02:55-05:00November 20, 2025|Louisiana|

Minnesota

The Department of Health (MDH) released the final updated Form and Manner for Prescription Drug Data Sets, as well as an updated Frequently Asked Questions Document. Updates impact reporting by all reporting entities, including manufacturers, wholesalers, pharmacy benefit managers and pharmacies.  

The updates reflect statutory changes from the 2025 legislative session (Laws of Minnesota, 2025 – 1st Special Session, chapter 3, article 2, sections 6-14) and responses to input received during the comment period. The updates include changes to align reporting elements, modified registration requirements and a change to the reporting period for reporting data on drugs of substantial public interest.  

MDH has updated the Rx Data Portal to integrate the statutory changes and make additional enhancements to support reporting entities. These updates are now live and available to all reporting entities. 

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

2025-11-20T10:02:24-05:00November 20, 2025|Minnesota|
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