Governor Ron DeSantis (R) issued an Executive Order to address the cost of prescription drugs in the state. The order directs all executive agencies to include provisions in all future contracts and solicitations with PBMs (Pharmacy Benefits Managers) (Pharmacy Benefit Manager), services that include the following:
- Prohibit spread pricing for all PBMs
- Prohibit reimbursement claw backs for all PBMs
- Directs agencies to include reporting requirements and data transparency, including a review of all rebates, payments, and relationships between pharmacies, insurers, and manufacturers
- Directs all impacted agencies to amend all contracts with these same provisions.
Also in Florida, the Agency for Health Care Administration (Agency) has been implementing Referring, Ordering, Prescribing, and Attending (ROPA) requirements as directed by the 21st Century Cures Act (Cures Act) and by the Centers for Medicare and Medicaid Services (CMS). Previous provider alerts on National Provider Identifier (NPI) requirements for ROPA providers can be found on the Agency’s website in the Provider Message Archive. Providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b).
In accordance with CMS requirements, all Fee-For-Service claims submitted October 1, 2022, or after from a non-exempt provider type that do not have a ROPA provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed below, all other provider type claims must have a ROPA provider identified by NPI on the claim for reimbursement by Florida Medicaid.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.