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So far Michael Silber has created 1944 blog entries.

New York

The State Department of Financial Services posted its proposed rulemaking for Pharmacy Benefit Managers regulation on May 24, 2023. The purpose is to establish rules for PBMs regarding assessments, license requirements, reporting and record keeping and to clarify definitions. Public comments are due 60 days from when this was published.

The NYRx Medicaid Pharmacy Benefit transition announced this week a 30-day countdown for transition fills. As you know, as of April 1, 2023, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs) and HIV-Special Needs (SNPs) began receiving their pharmacy benefits through NYRx, the Medicaid Pharmacy Program. 

To ensure a smooth transition for members, NYRx instituted a transition fill period from April 1, 2023, to June 30, 2023. During the transition period, members were provided a one-time transition fill for up to a 30-day supply of a drug that would normally require prior authorization (PA) under the NYRx Preferred Drug Program (PDP). The one-time transition fill does not mean that a PA will not be required for future fills. Beginning on July 1, 2023, all claims will be subject to NYRx pharmacy program criteria listed on the NYRx PDL.

PAs issued by Medicaid Managed Care plans prior to April 1, 2023 (that are active/valid after April 1, 2023) will continue to be honored by NYRx. This includes clinical PAs that may also require PA under NYRx. The state encourages members to continue to use the portal and call with any issues. The upcoming change of note is starting July 1, 2023; all claims will require a prior authorization via the IVR/Portal System (with some exceptions). 

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

2023-06-02T10:33:52-04:00June 2, 2023|New York|

Ohio

The Department of Medicaid (ODM) announced that on July 1, 2023, they will transition pharmacy benefits for Medicaid Fee-for-Service (FFS) enrollees to Gainwell, their single pharmacy benefits manager (SPBM). This transition consolidates oversight of Medicaid pharmacy benefits for managed care and FFS members, giving prescribers and providers one vendor to work with regardless of how their patients are enrolled in Medicaid. Beginning July 1, Medicaid FFS prescribers and pharmacies will route claims to Gainwell’s new BIN 024251 and PCN OHRXPFFS. This information will be included on the new FFS member ID cards, but they will retain their current member ID numbers. The Pharmacy Reference Guide and Payer Sheet has been updated to reflect the changes. For questions about the transition, please email MedicaidSPBM@medicaid.ohio.gov

Also in Ohio, the Board of Pharmacy’s final rule on pharmacists’ immunizations authority was published, effective June 1. The rule reflects the passage of HB 6 of 2021 (134th GA). It updates the state’s current practice to permit pharmacists to administer: Flu and COVID vaccines by protocol or vaccines for “any other disease” with a prescription to patients aged 7 years and older; and “any disease” under a protocol. Further regulations concerning technician and intern vaccines required under HB 6 are still in the rulemaking process. NACDS continues to work with our in-state partners and the Legislature to pass legislation to bring pharmacy immunization authority in line with the PREP (Public Readiness and Emergency Preparedness) Act. 

Finally in Ohio, on May 24 the Board of Pharmacy posted numerous guidance documents regarding pharmacy technician and technician trainee registration, reciprocity and training programs. To view the documents please go to Pharmacy.Ohio.Gov. 

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

2023-06-02T10:31:17-04:00June 2, 2023|Ohio|

Oklahoma

With two-thirds support in both houses, on May 17, lawmakers, not Gov. Kevin Stitt (R) called a special legislative session to get more time to finalize the state’s $12.8 billion budget for the upcoming fiscal year and to ensure that they get the final say on any bills they pass. The special session ran concurrently with the regular legislative session that adjourned sine die on May 26. The special session gives lawmakers the ability to come back in June if they need to override any of Gov. Kevin Stitt’s vetoes on budget bills or related pieces of legislation. 

The legislature officially adjourned the regular session on May 26. Prior to adjournment, lawmakers overrode 13 bills that Gov. Kevin Stitt’s (R) vetoed, including HB 1843, legislation that moves the enforcement authority over PBMs from the Insurance Commissioner to the Attorney General, effective November 1, 2023. 

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

2023-06-02T10:28:32-04:00June 2, 2023|Oklahoma|

Oregon

The June 7-9, 2023 Board of Pharmacy Meeting agenda and meeting materials are now available. Additional meeting materials may be added to the agenda prior to the board meeting. Visit the board website for current meeting materials. 

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

2023-06-02T10:24:02-04:00June 2, 2023|Oregon|

Rhode Island

The June 2023 provider update can be found here. Previous issues can be found on the EOHHS [Executive Office of Health & Human Services] website at the provided link above. 

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

2023-06-02T10:22:14-04:00June 2, 2023|Rhode Island|

Tennessee

To assist prescribers and providers, prior authorization (PA) requirements can be bypassed for certain medications when specific medical conditions exist. Those specific medications and diagnoses can be found here. Prescribers are encouraged to include the applicable diagnosis code on written prescriptions for inclusion on the electronic pharmacy claim. 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). We encourage you to review this information thoroughly and contact the OptumRx Pharmacy Supports Center at 866-434-5520 or tnrxeducation@optum.com should you have questions. 

Also in Tennessee, TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL 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. 

Finally in Tennessee, effective July 1, 2023, TennCare members will be able to obtain Continuous Glucose Monitors (CGMs) and supplies from their local in network retail pharmacy. This new coverage pathway will not affect coverage under the medical plan. This update allows TennCare members to access CGMs and related supplies through either their pharmacy OR medical program. Under this new coverage pathway, prescriptions for CGMs and maintenance supplies may be sent to your patient’s in-network pharmacy of choice. 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 information, contact NACDS’ Leigh Knotts at 803-243-7207.

2023-06-02T10:21:40-04:00June 2, 2023|Tennessee|

Texas

The legislature adjourned sine die at 6:00 p.m. on May 29. Prior to adjournment, the Senate and the House finalized the $321.3 billion state budget for the two-year cycle beginning on September 1, 2023. They also passed and sent Gov. Greg Abbott (R) several bills of interest to pharmacies, including: 

  • HB 25, creates the Canadian Wholesale Prescription Drug Importation Act to provide lower cost prescription drugs for consumers; 
  • HB 4990, establishes the Texas Pharmaceutical Initiative governing board and advisory council, a Texas State PBM; 
  • HB 1283, retains the single Medicaid managed care organizations formulary and preferred drug list; 
  • SB 2173 requires the Texas State Board of Pharmacy (TSBP) to develop and implement a prescription drug safe disposal pilot program. 

Also in Texas, unfortunately on day 138 of the 140-day Texas legislative session, HB 1105, the PREP Act permanent immunization legislation that passed both houses with more than a 2/3’s vote, died at midnight because Sen. Lois Kolkhorst (R) refused to appoint Senate conferees to negotiate with House conferees on the anti-COVID mandate amendments the Senator added to the bill before it passed the Senate on May 23. 

Finally in Texas, on May 24, the House General Investigating Committee released information regarding its investigation of Attorney General Ken Paxton (R). Paxton had met with legislators early in session requesting $3.3 million of taxpayer’s money in the state budget to settle a lawsuit between the Attorney General and former staff members. The lawsuit revealed the four former executives were fired in retaliation for reporting the Attorney General to authorities which violated the Texas Whistleblower Act. On May 27, the full House debated HR 2377, the 20 articles of impeachment. The resolution passed with a vote of 121 to 23 and was delivered to the Senate where the trial will begin by August 28. Gov. Greg Abbott (R) appointed John Scott to serve as the short-term interim Attorney General until a decision in the impeachment trial is reached. 

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

2023-06-02T10:20:37-04:00June 2, 2023|Texas|

Wyoming

The Board of Pharmacy adopted the following emergency rules effective April 14, 2023. 

Also in Wyoming, the Board of Pharmacy announced a Notice of Intent to Adopt Rules impacting the following chapters. Comments may be submitted to bop@wyo.gov by June 21, 2023. 

  • Chapter 3: Pharmacy Internship Regulations 
  • Chapter 6: Continuing Professional Education Regulations 
  • Chapter 16: Immunization Regulations  
  • Chapter 18: Prescribing by Pharmacists  

Finally in Wyoming, the Board of Pharmacy adopted the following rules effective May 24, 2023: 

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

2023-06-02T10:19:25-04:00June 2, 2023|Wyoming|

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