California
Medi-Cal Rx posted the following alerts. To view all alerts, visit Bulletins & News on the Medi-Cal Rx website.
- Claim Submission Reminders (January 11)
- Prior Authorization Required: Reject Code 75 (January 9)
- Pharmacy Claims Reject Code 65 – Resolved (January 9)
- Alert Summary for the Week of January 3-7 (January 7)
Also in California, note the recently issued Billing Guidance for Pharmacy Providers on COVID-19 Oral Antivirals (January 6).
Also in California, the Board of Pharmacy issued a pharmacy law waiver for Prescriber Dispensing of COVID-19 Oral Therapeutic Medication to Emergency Room Patients.
Finally in California, the Board of Pharmacy has rescheduled its next quarterly two-day meeting. The new meeting dates are January 27-28. Committee meeting materials have also been posted.
- January 18, 2022
- January 19, 2022
- Licensing Committee, 9 a.m.
- Communication and Public Education2:30 p.m.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Health Care Policy and Finance (HCPF) announced today that they received approval from CMS to further increase the Health First Colorado and CHP+ reimbursement rate for COVID-19 vaccine administration to $61.77 for the first two doses, retroactive to September 1, 2021. This rate is triple the typical Medicaid vaccine administration rate and 50% above the Medicare rate.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Delaware
The Delaware Board of Pharmacy has proposed revisions to its rules and regulations. All comments are due by February 3, 2022.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Illinois
The Illinois Department of Healthcare and Family Services has posted a new Provider Notice regarding Pharmacy Instructions for COVID-19 Vaccine for Children Ages 5-11. You may view the new Notice at the following link as well as a new Provider Notice regarding Pharmacy Billing of Subcutaneous Monoclonal Antibody Treatment. You may view that new Notice at the following link.
Also in Illinois, the Illinois Department of Healthcare and Family Services has posted an Updated DME Fee Schedule. Please note: Corrections have been made to codes L0637, A4230 and A4231. You may view the new Fee Schedule at the following link.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Human Services published INFORMATIONAL LETTER NO. 2305-MC-FFS-CVD to inform providers about pharmacy coverage of oral COVID-19 therapeutics. See "Pharmacy Coverage Summary" on page 2.
Also in Iowa, the Board of Pharmacy published its November 10, 2021 meeting minutes.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
Rep. Steve Sheldon (R) has introduced legislation to comprehensively regulate Pharmacy Benefit Managers. House Bill 203 would regulate PBMs in commercial and self-insured plans, as well as the state employee plan. The bill includes patient choice of pharmacy protections and measures that protect pharmacy reimbursed. It would also prohibit mandatory mail order, require any rebates to reduce patients’ out-of-pocket costs and set a pharmacy reimbursement floor based on NADAC + professional dispensing fee. Additionally, it would require PBMs to treat 340B claims like other prescription claims for reimbursement purposes.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Referencing the federal law and regulations, the Board of Pharmacy's Regulation Revision Committee sent to the full Board for final consideration at the February 16 meeting draft CLIA guidelines confirming that properly credentialed pharmacies may perform moderately complex lab testing.
Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing issued a Provider Update on reimbursement for COVID-19 booster shots and third doses for Medicaid Fee for Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs). Effective January 18th, Louisiana Medicaid will reimburse enrolled pharmacies for the administration fee or $37.08 or billed charges, and not for the ingredient for COVID-19 vaccines. No dispensing fee shall be reimbursed.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The Maryland Insurance Administration (MIA) has released its report on the impact of Rutledge v. PCMA and the subsequent Webhi decision on Maryland law and the MIA’s ability to regulate Pharmacy Benefits Managers (PBMs) and their relationship with pharmacies in Maryland. The report was mandated by the passage of HB 601 of 2021. It concluded that, should the legislature pass legislation regulating PBMs when providing services to an ERISA plan, ERISA would not preempt the MIA’s enforcement of those laws. The report also provides a summary of previously passed laws related to PBMs in Maryland and MIA’s current methods of enforcing them. The report cites comments from NACDS and the Maryland Association of Chain Drug Stores submitted last fall, which highlighted examples of pro-pharmacy laws that align with the Rutledge decision.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Gov. Parson's (R) ended the COVID-19 State of Emergency on December 31, 2021, ending all remaining COVID-19 related waivers authorized under EO 21-09. The Board of Pharmacy issued guidance on the expiration of the Emergency Declaration.
Also in Missouri, the Department of Social Services MO Health Net (Medicaid) clarified reimbursement for COVID-19 antiviral treatment. Pharmacy providers filling prescriptions for Paxlovid or molnupiravir will be reimbursed the current professional dispensing fee at the time the prescription is dispensed. For pharmacies to receive the full dispensing fee, the Usual & Customary charge submitted to MO HealthNet must be more than the current professional dispensing fee. Non-pharmacy providers such as clinics, hospitals, and ERs do not receive a professional dispensing fee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
Effective January 1, 2022, prescribers shall use electronic prescription technology for controlled substance prescriptions with exceptions.
Also in Nebraska, the Department of Health and Human Services announced the next COVID-19 Medicaid Provider call will take place on January 19 at noon (Central).
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Hampshire
The Board of Pharmacy is accepting comments on proposed revisions of the unused drugs program. Comments are due by February 16, 2022.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New Jersey
The Board of Pharmacy has adopted regulations on opioid warning labels. These regulations are effective January 3, 2022.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New Mexico
The Department of Health renewed the order requiring wearing masks indoors.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
The New York State Department of Health has proposed to amend regulations to limit the Medicaid fee for service prescriptions to a maximum of 11 refills within a 12-month issuance. Comments are due by March 6, 2022.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
The January 18th Board meeting will be conducted via Microsoft Teams. You will be able to join the meeting either by downloading the Microsoft Teams app or you may open the link in a web browser. Simply click on this link at the start of the meeting. If you prefer to attend the meeting by phone, call (336) 604-5350. The conference ID is 907 040 796#. You may view the agenda here.
Also in North Carolina, NC Medicaid is increasing the reimbursement for COVID vaccine administration from $40 to $65. The effective date of the rate change will be retroactive to April 1, 2021. All claims previously submitted with dates of service from April 1, 2021, through the NCTracks implementation date of the rate change will be systematically reprocessed. No action will be required by providers to receive the retroactive rate increase.
Finally in North Carolina, the Board of Pharmacy issued the following guidance regarding the role of pharmacists in oral therapeutics to treat COVID-19.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
North Dakota
Blue Cross Blue Shield of North Dakota is providing coverage to the Medicaid expansion population effective January 1, 2022. See the Medicaid Expansion Provider Manual for information to submit claims for pharmacist administered vaccines.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
The Board of Pharmacy ‘s January 19, 2022, Board Meeting will be shown via YouTube. The meeting will begin at 9:00 am. View the agenda here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Dakota
The Board of Pharmacy published its January 2022 Newsletter, including information about the new Prescription Drug Monitoring Program NarxCare Report called “Tile View”, an update on the drug take-back program, and other information of interest to pharmacies and pharmacists.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Virginia
The Virginia Department of Health (VDH) has issued an updated COVID-19 standing order to include the latest CDC recommendations.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The State Health Care Authority (HCA) issued a statement that while they are not able to implement at this time, HCA is working to create a process to meet these legislative mandates in a law passed last year, Substitute Senate Bill 5195. The law requires HCA to reimburse hospitals, behavioral health agencies, or pharmacies who dispense opioid overdose reversal medication to uninsured individuals by January 1, 2022. The plan will include a process to back-dated opioid reversal medication claims to January 1, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wisconsin
The 2022 list of 100 most used generic prescribed drugs has just been released. Each Wisconsin pharmacy must provide notice to the public on how it may access the Pharmacy Examining Board list.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Alabama
Effective January 1, 2022, the Alabama Medicaid Agency will have contracts with eight companies that offer Medicare Advantage coverage in Alabama: Aetna Better Health, Inc., Arcadian Health Plan, Inc. (Humana), Centene Venture Company Alabama Health Plan, Inc. (Ascension Complete), HealthSpring Life & Health Insurance Company, Inc. (CIGNA), Simpra Advantage, Inc., UnitedHealthcare of the Midlands, Inc., VIVA Health, Inc., and WellCare of Alabama, Inc.
Providers are encouraged to check Medicaid's Eligibility Verification File, under the Managed Care Section, to determine if capitation payments have been made for recipients during a particular month. If a capitation payment has not been made, providers should refer to Chapter 5 of the Provider Billing Manual, Sections 5.6.1 – 5.6.2, for claims filing instructions. Questions may be directed to Shari Rudd at (334) 353-3403 or shari.rudd@medicaid.alabama.gov.
Also in Alabama, the Board of Pharmacy is reporting that only 35% of licensed technicians have renewed their licenses. Please be aware that the submission of a renewal by the December 31 deadline does not mean that individuals are clear to work on January 1. The renewals must be processed, not just submitted. We recommend that you renew your license NOW, with plenty of lead time to handle any issues that may come up.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arkansas
The Division of Medical Services rules allowing six refills per month, add certain medications that do not count toward the monthly prescription cap, and allow up to nine medically necessary prescriptions per month for Living Choices Assisted Living Program clients went into effect on January 1, 2022. The rule also specifies that patients must pay for their own medications beyond the maximum benefit, remove the extension of benefits provisions, and revise refill requirements.
Also in Arkansas, the Division of Provider Services and Quality Assurance (DPSQA) issued a COVID-19 Response Manual.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Medi-Cal Rx was implemented on January 1, 2021. The Monthly Bulletin for January has been posted to the Medi-Cal Rx Web Portal.
Also in California, Medi-Cal Rx issued a Share of Cost bulletin to clarify that the process will be unchanged by the implementation of Medi-Cal Rx.
Also in California, Medi-Cal Rx issued an alert announcing that reject code 16 M/I Prescription/Service Reference Number is temporarily suspended. Pharmacy providers may resubmit claims if they receive this rejection.
Also in California, the Board of Pharmacy published its January 2022 monthly update. Note the last item about pharmacy laws effective in 2022.
Finally, the Board of Pharmacy also published a reminder of the new e-prescribing laws effective January 1, 2022.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
The Department of Health has issued a Notice of Meeting/Workshop Hearing. The Board of Pharmacy will conduct a workgroup meeting to discuss white bagging and brown bagging pharmacy practices, February 9, 2022, 1:00 p.m. ET at the DoubleTree by Hilton Hotel Deerfield Beach – Boca Raton, 100 Fairway Dr., Deerfield Beach, FL 33441.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.