The Department of Health (LDH) issued a memo clarifying they are continuing to reimburse pharmacies for at-home OTC COVID-19 diagnostic tests to Medicaid patients through December 31, 2024.
Also in Louisiana, on September 9, 2024, Governor Jeff Landry declared a state of emergency for Tropical Storm Francine. LDH issued a memo detailing the procedures for emergency prescriptions claims for Medicaid beneficiaries
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Board of Pharmacy held a pharmacy rule-making subcommittee meeting on September 16, 2024, regarding updating the board rules. The subcommittee goals are
They reviewed chapters four and five of rules, which cover registration and continuing education. The next meeting will be October 21, 2024.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Sen. Santana has introduced SB 993, a “trailer” bill that require insurers to reimburse pharmacies for the vaccination and test and treat services authorized under P.A. 97 of 2023. The bill was referred to the Senate Health Policy Committee and could see action as early as this fall.
Also in Michigan, the Department of Health, and Human Services (MDHHS) has issued a final bulletin ending three temporary COVID-19 Medicaid Pharmacy provisions due to the COVID-19 PHE.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
DHS has published a provider update with details about the November 4th transition to the new claims processing system. On October 16 they will host what they anticipate will be the last provider virtual meeting prior to implementation and have posted the call in information. Lastly, they have also released the payer specification document for claims processing and billing.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The New Hampshire Board of Pharmacy will be holding a hearing on September 25, 2025, at 9:30 am to review the repeal of three rules. The three rules being repealed are (1) in regard to unused prescription drugs, (2) the New Hampshire Controlled Drug Prescription Health and Safety Program, and (3) Continuous Quality Improvement. In lieu of attending, written comments can be submitted to OPLC-Rules@oplc.nh.gov.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
On September 5, Governor Hochul signed into law the Retail Workers Safety Act, which requires employers to implement policies and training programs to prevent workplace violence. It requires a retail store with 500 or more employees to install panic buttons in all New York locations. The Department of Labor would be required to create a model workplace violence prevention training program, policy, and guidance document to be utilized by employers. The law is effective March 4, 2025, however the section requiring panic buttons would take effect January 1, 2027.
On September 13, 2024, the New York Pharmacy Conference held its regular meeting. The meeting included updates from Donate Life New York State, the Comprehensive Contraceptive Coverage Act, and Expansion of Collaborative Drug Therapy Management to offsite practices, and a legislative update from Assemblyman John McDonald. The next meeting of the conference will be held on Friday December 13, 2024, at 10 AM.
On September 18, 2024, the New York Department of Health held their monthly pharmacy industry call regarding NYRx, the Medicaid Fee-For-Service Program. This month’s call included updates on Blood Glucose Test Strip Coverage Policy and Covid Tests Coverage Policy Update.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
The Board of Pharmacy published the following final rules:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Prescription Drug Affordability Board (PDAB) moved its next meeting from September 18 to October 2 due to unforeseen scheduling issues and lack of a quorum. The agenda has been updated to reflect this change. Please note the “Medicare MFP modeling presentation and SB 192 upper payment limit discussion” by PDAB staff and Myers and Stauffer on the agenda. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Effective October 1, 2024, over the Counter (OTC) COVID-19 testing kits will no longer be covered under TennCare’s pharmacy benefit due to the end of the COVID-19 Public Health Emergency. Beginning October 1, 2024, Covid Test Kits will remain a covered benefit under the medical benefit.
Effective September 1, 2024, TennCare began reimbursing pharmacy providers through the OptumRx Pharmacy Point of Sale System (POS) for the administration of newly FDA approved COVID-19 vaccines for the 2024-2025 Formulas. Per FDA guidance, previous versions of COVID-19 vaccines are no longer recommended or authorized for use. CoverKids and CoverRx claims also follow this FDA guidance.
Claims for COVID-19 vaccines are exempt from co-pays and script limits for all TennCare enrollees.
COVID vaccine claims for dual eligible members (Both Medicare and Medicaid eligible) will receive NCPDP Reject 65 “Patient has Medicare Coverage, Bill Medicare.”
Please note for TennCare members, effective October 1, 2024, the Covid-19 vaccine reimbursement will change to include only the cost of the vaccine plus the Professional Dispensing Fee (PDF). The $40 administration fee will be discontinued. Therefore, the Incentive Amount Submitted (NCPDP Field 483-E3) is no longer required for claim submission. If you have a TennCare Medicaid ID, you may contract with the individual Managed Care Organization(s) to bill for ancillary services. Please contact the designated health plan Provider Services for assistance.
Also in Tennessee, prior authorization requirements can be bypassed for certain medications when specific medical conditions exist. The submitted claim should include a Diagnosis Code Qualifier (Field # 492- WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). See a list of the preferred agents and the clinical criteria here, and see the list of Tennessee OptumRx Provider Liaisons here.
Finally in Tennessee, the Tennessee Pharmacists Research and Education Foundation (TPREF) is proud to offer an ACPE-accredited OSHA training webinar that meets all of OSHA’s annual training requirements, with ten sessions offered between September 25 and October 23. Register for one of the sessions!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
