New York
NYRx, the New York State Medicaid Pharmacy Program, provided an update to its prior authorization program, effective August 1, 2024.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
Gov. Roy Cooper (D) declared a State of Emergency effective August 5, 2024, and it will remain in effect for 30 days. The Order activates the State Emergency Operations Plan and allows for the Department of Transportation and the Department of Public Safety to take the appropriate action to ensure the expeditious movement of utility vehicles to eliminate power outages, vehicles carrying essential supplies such as food, medicine and fuel or transporting livestock, poultry and crops. This order also triggers the Price Gouging Law.
Also in North Carolina, effective August 1, 2024, Medicaid beneficiaries may obtain the over the counter (OTC) oral contraceptive Opill without a prescription and at no cost. While Medicaid encourages establishing care with a medical home, coverage without a prescription allows Medicaid beneficiaries easy access to the product and reduces barriers such as having to make an appointment to get a prescription, needing transportation to the appointment or even a lack of health care providers in the community. Medicaid beneficiaries will be able to get Opill from pharmacies enrolled in Medicaid who will be able to submit the claim for reimbursement. A $5.00 fee will be included in the reimbursement amount paid to the pharmacy. A dispensing fee will not be paid. Beneficiaries are allowed to obtain up to a 3-month supply of Opill with each request, without a prescription, with a maximum of 13 packs per year. Opill is a progestin only contraceptive. Pharmacists should counsel beneficiaries that Opill is most effective when taken once a day at the same time each day.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
Effective August 12, 2024, OAC 4729:5-2-05 requires all outpatient pharmacies located in Ohio to submit notification to the Board of Pharmacy of the types of language translation services, hearing impairment services and vision impairment services they offer patients using the Board’s accessible services reporting webpage. Pharmacies are required to use this webpage to notify the Board of these accessible services. NOTE: The website (www.pharmacy.ohio.gov/ASreport) will go live on August 12, 2024; however, the requirement to submit notification of accessible services does not take effect until November 10, 2024. Chains can bulk report for all their locations but can only make changes moving forward by individual locations. The Board will issue a notification about the program to pharmacies on August 12. For now, only draft guidance is available.
Also in Ohio, the Department of Health is working with Innovation Horizons, a health consulting organization, to build up programs for diabetes prevention and management by increasing the number of pharmacies providing National Diabetes Prevention Program (DPP)/ Diabetes Self-Management Education and Support (DSMES) services to their patients. To better gauge the resources needed and capacities for pharmacies in the state, they created a survey for pharmacies to complete. Pharmacies are encouraged to complete the survey, if appropriate, as it may lead to further opportunities for patient care.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) posted the draft agenda for its next meeting on August 21. Please note the presentation by Myers and Stauffer titled “SB 192 Upper Payment Limit Deliverable” on the draft agenda. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The Department of Human Services published a bulletin to make providers aware of upcoming changes to its domain and URLs in the PROMISe payment system.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Gov. Henry McMaster (R) issued Executive Order 2024-16, declaring a State of Emergency in preparation for the potential effects of Tropical Storm Debby. Tropical Storm Debby is expected to produce rainfall totals of 10 to 20 inches, with maximum amounts of 30 inches, across portions of coastal South Carolina through Friday morning. This potentially historic rainfall may result in areas of catastrophic flooding. For power outages and shelter information, visit the S.C. Emergency Business Resources Dashboard. If your business sustains any damage during the storm, please be prepared to notify ESF-24 with as much detail as possible. ESF-24 will provide updates when assistance becomes available or business recovery centers open.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
TennCare announced the list of covered UPCs for its upcoming diaper program. Luvs, Pampers, Huggies and Cuties are the primary brands that will be covered. If your pharmacy plans to participate and wants to be featured on the TennCare website as a participating location, complete this survey.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
NACDS Mary Staples, Walgreens pharmacist Aimme Lusson, and Kroger pharmacist Jeff Loesch, met with State Sen. Bryan Hughes (R) and State Rep. Candy Noble (R), two champions for PBM reform legislation, at the Texas Pharmacy Association’s annual meeting in Allen, Texas.
Also in Texas, the Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP) delayed the semi-annual Medicaid preferred drug list update until August 8, 2024.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Vermont
Medicaid has updated its contact information due to the transition of Change Healthcare (CHC) to Optum.
| Contact | Old | New | |
| Help Desk | PBA_VTHelpdesk@changehealthcare.com Physicians: (p)1-844-679-5363 (f) 1-844-679-5366 Pharmacies: (p)1-844-679-5362 | VermontHD@optum.com Note: Phone and Fax numbers remain the same | |
| Provider paper billing address | 1 Green Tree Drive South Burlington, VT | 45 Commerce Dr, Suite 5 Augusta, ME 04330 | |
| PA Fax | Remains the same: 1-844-649-5366 | ||
Also in Vermont, the Department of Vermont Health Access (DVHA) continues a phased recovery following the outage that occurred in February 2024, due to the national cyber security issue affecting Optum/Change Healthcare. Beginning August 7, 2024, edits for Reject-75, Prior Authorization Required, will return to normal functioning in the pharmacy claims system.
- Claims for non-preferred items on the Preferred Drug List (PDL), including medications obtained during the outage, that do not have an active Prior Authorization on file, will now begin to reject. This also includes preferred medications subject to clinical review and medications requiring step therapy. Please refer to the PDL for medication specific coverage criteria.
- An emergency fill can be dispensed when a required prior authorization has not been secured, and the need to fill the prescription is determined to be an emergency. If the prescriber cannot be reached to obtain the required prior authorization, the pharmacist may dispense an emergency supply to last up to 72 hours.
Please continue to refer to the Preferred Drug List to review preferred and non-preferred medications. Providers requiring assistance with submitting a prior authorization may contact the Optum Pharmacy Helpdesk at VermontHD@Optum.com, the Prescriber Helpdesk at (1-844-679-5363) or the Pharmacy Helpdesk at (1-844-679-5362).
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.