On May 16, the State Department of Health held a monthly NYRx Medicaid Pharmacy Benefit transition call for pharmacies. 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.
The Board of Pharmacy posted numerous guidance updates related to the expiration of the Public Health Emergency and the policies and waivers they adopted during the COVID pandemic, including:
To view the full list, go to Pharmacy.Ohio.Gov.
Also in Ohio, the Ohio Department of Medicaid and Gainwell Technologies are continuing the reimplementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations. It does not apply to those patients who have previously taken the drug supported by recent claims history prior to May 23, 2023. Phase 6 of reimplementation will begin on May 23 and contain the following:
Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see products that require a PA. PAs may be submitted via phone, fax, mail and the SPBM portal. Please direct questions to the Gainwell Technologies Help Desk at 1-833-491-0344.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Oregon Health Authority Public Health Division (OHA-PHD) announced a public hearing via Zoom on OHA-PHD’s proposal for the use of funds from the Preventive Health and Health Services Block Grant on May 31 from 1:00 p.m.-1:30 p.m. The draft proposal will be posted at www.healthoregon.org/lhd prior to the meeting. Program contact is Sara Beaudrault.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
On May 16, Gov. Henry McMaster (R) signed into law NACDS’ priority PBM reform legislation Senate Bill 520. The measure takes effect January 1, 2024; however, the Department of Insurance is prohibited from performing audits of PBMs before January 1, 2025. South Carolina’s regular legislative session has adjourned Sine Die; however, Governor McMaster has called the legislature back into special session to discuss abortion legislation.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Department of Commerce and Insurance (TDCI) has launched a new, updated website. This website has direct links to the Standard Pharmacy Reimbursement Appeal Form and the formal Pharmacy Benefit Manager Complaint Form. The complaint form is fully electronic now to add ease of use on pharmacies and patients to submit complaints to TDCI.
Also in Tennessee, please see the provider notice regarding Sedative Hypnotic Benefit Limits. We encourage you to review this information and contact the OptumRx Provider Liaisons at tnrxeducation@optumrx.com with any further questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
HB 1105, by Sen. Pete Flores (R) and Rep. Four Price (R), legislation that lowers the age to three years old and up for pharmacies to administer all vaccines and immunizations, is awaiting a hearing date in the Senate Health and Human Services Committee. NACDS and Texas Federation of Drug Stores’ (TFDS) chain pharmacists and independent pharmacists descended on the Capitol this week to educate all 31 Senate offices on the merits of the bill, sharing a Coalition letter signed by 13 Texas organizations, and passing out several pharmacy groups one-pagers explaining the bill. Late Thursday evening, the bill was posted for an 8:00 a.m. hearing on Friday morning in the Senate Health and Human Services Committee. Then an hour later, the Committee Chair, Senator Lois W. Kolkhorst (R), removed the bill from the agenda because of a disagreement with Sen. Flores.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
On May 12, the Vermont legislature approved HB 305, which would revise the definition of pharmacy technician to mean an individual who, only while assisting and under the supervision of a licensed pharmacist, performs tasks relative to dispensing prescription drugs, administering immunizations and performing tests for SARS-CoV. Pharmacy technicians may administer immunizations and perform tests for SARS-CoV. This measure also outlines requirements for pharmacy technicians in order to administer immunizations. They may only administer immunizations to individuals 18 years of age and older. Regarding patients five years old and older for flu and COVID-19 vaccines, a licensed pharmacist must be present to assist as needed. Pharmacy technicians may only administer immunizations that: (1) are recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; and (2) licensed pharmacists are permitted to administer under the State clinical pharmacy protocol. This measure allows a pharmacist to prescribe, order or administer self-administered hormonal contraceptives, including subcutaneous depot medroxyprogesterone acetate as well as, for patients 18 years of age or older, vaccinations recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) and administered consistently with the ACIP-approved immunization schedules, as may be amended from time to time. Lastly, this measure exempts persons dispensing over-the-counter hearing aids from provisions for audiologists and hearing aid dispensers. The bill now awaits signature from the Governor.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Board of Pharmacy has posted the agenda for the May 23 Regulation Committee. Note the agenda includes a chart of regulations in progress, including the “working environment” regulations that are currently in the Governor’s office.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
On May 3, Kristin K. Mayes, Attorney General, added her signature to the Board of Pharmacy’s emergency rules allowing a pharmacy technician to administer a vaccine when the technician has completed specified training and the authority to administer the vaccine is delegated by and under the supervision of the pharmacist on duty. The rule will be effective when filed with the Office of the Secretary of State.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.