On September 28, Gov. Gavin Newsom (D) vetoed SB 966, PBM reform legislation that would have required licensure by the Department of Insurance among other provisions supported by NACDS. In his veto message, the Governor said the public and the Legislature need a clearer understanding of how PBM practices are driving up prescription drug costs and explained the need for more granular information to fully understand the cost drivers in the prescription drug market and the role that PMBs play in pricing. Gov. Newsom directed the Health and Human Services Agency to propose a legislative approach to gather much needed data on PBMs next year, which can be considered in conjunction with data from the state’s Office of Health Care Affordability (OHCA) reflective of the state’s entire health care delivery system.
Also in California, effective for dates of service on or after October 1, 2024, the Department of Health Care Services announced Medi-Cal pharmacy providers are eligible to supervise and bill for Community Health Worker (CHW) services when billed with CPT® codes 98960, 98961 and 98962. Modifier U2 is required when Pharmacy providers bill for claims for services rendered by CHWs.
Also in California, the Department of Health Care Services posted the following alerts and weekly notice on the Medi-Cal Rx Web Portal:
- Updated COVID-19 Vaccine Reimbursement Rates
- Medi-Cal Rx Provider Portal Prior Authorization Submission Update: Member Validation Enhancement
- Medi-Cal Rx Weekly Wrap-up for September 20-26
Finally in California, the Board of Pharmacy posted the agendas for the following meetings:
- Enforcement Committee – October 16 – Agenda – Note review of 2024 legislation and discussion and consideration of FDA actions related to the Drug Supply Chain Security Act (DSCSA).
- Licensing Committee – October 17 – Agenda – The following items may be of interest:
- Presentation by the California Pharmacists Association on Assembly Bill 317 (Chapter 322, Statutes of 2023) related to Pharmacist Service Coverage
- Discussion and Consideration of Proposed Changes to Board-Provided Training for Furnishing HIV Preexposure and Postexposure Prophylaxis
- Discussion and Consideration of Proposed Follow-up Survey on Working Conditions
Open Discussion on Payor Practices that Negatively Impact Patient Care
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.