Delaware
The Board of Pharmacy is scheduled to hold its regular meeting on October 16 at 9:30 am. On the agenda is a discussion of legislation: HB 383, an Act to prohibit discrimination against 340B drug distribution.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Florida
In anticipation of the impact of Hurricane Milton, Gov. Ron DeSantis (R) issued Executive Order (EO) 24-215, amending EO 24-214 and declaring a state of emergency for 51 counties. The State Surgeon General signed Emergency Order 24-003, which among other items, permits pharmacies and prescription department managers to operate in multiple or mobile locations.
Also in Florida, effective September 30, Florida’s minimum wage increased from $12.00 per hour to $13.00 per hour. This increase is a result of Constitutional Amendment No. 2 passed by voters in the 2020 election. In accordance with the amendment, the minimum wage is set for annual increases on the path to a $15 minimum wage by September 30, 2026. The requirement applies to both public and private employers, regardless of size. Florida Statutes requires employers who must pay their employees the Florida minimum wage to post a minimum wage notice in a conspicuous and accessible place in each establishment where these employees work. Please download the updated 2024-2025 minimum wage poster and display accordingly to ensure you are following posting requirements.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
After six years of service, the Deputy Secretary and Chief of Staff Kim Opsahl departed the Family and Social Services Administration (IFSSA) on October 11.
Also in Indiana, the Health Coverage Programs (IHCP) has a new Claims Submission and Processing Manual.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services (HHS), Iowa Medicaid posted INFORMATIONAL LETTER NO. 2630-MC-FFS 2024 Pharmacy Dispensing Fee Increase. Effective October 1, 2024, the Iowa Medicaid dispensing fee increased from $10.38 to $10.63 based on the 2022 Cost of Dispensing survey.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
MedImpact issued a communication to pharmacies this week as a reminder about each managed care organizations (MCO) lock-in policy, including a list of each MCO’s criteria.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health issued Informational Bulletin 24-33. Open Enrollment for Medicaid members starts on October 15 and ends on December 2. During this period, members may change their health or dental plans without a qualifying reason.
Maine
The Prescription Drug Affordability Board met on October 7. The meeting’s main purpose was to finalize the draft for the questionnaire for public payors and to provide an update from the legislative planning workgroup, specifically concerning LD 1829. The Board is scheduled to meet next on November 25 at 10:30 am.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Maryland
The Prescription Drug Affordability Board (PDAB) and Stakeholder Council (PDASC) announced upcoming meeting schedules:
- The Prescription Drug Affordability Board Stakeholder Council (PDASC) will meet on November 4 at 2:00 pm. The meeting information page includes a link to register for the virtual meeting. They will not meet on October 21 or 28.
- The Prescription Drug Affordability Board (PDAB) will only have one meeting in October; a virtual Ad-Hoc meeting is scheduled to be held on October 28 at 2:00 pm. The meeting information page includes a link to register and additional information.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
On October 4, MassHealth released the results of its cost of dispensing study. It was announced that the proposed updated dispensing fee for chain pharmacies will be reduced by $1.51 per prescription from $10.02 to $8.51. This proposed change is scheduled to take effect on July 1, 2025. The dispensing fee for independent pharmacies will be increased by 19 cents to $10.21. The division also announced a policy change that will require managed care organizations (MCOs) to pay the MassHealth fee-for-service rate to independent pharmacies instead of the current managed care contract rate. MCOs will continue to pay chain pharmacies the negotiated contract rate. The raw data from the cost of dispensing survey is expected to be made available within the next two weeks. The proposed amendments will be submitted to CMS for its approval.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Michigan
The Board of Pharmacy posted a notice and agenda for a Rules Committee Workgroup on November 4. Instructions for attending the meeting are included in the notice.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Looking for ways to reduce healthcare costs for Missourians, six Senators have been named to the newly formed Senate Interim Committee on Driving Down the Cost of Healthcare. The committee will issue a report and recommendations by the end of the year
Also in Missouri, effective October 1, the MO HealthNet Pharmacy program discontinued coverage for at-home COVID-19 tests dispensed as a kit for at-home use. COVID-19 testing will continue to be covered for MO HealthNet participants when administered by a MO HealthNet enrolled provider.
Finally in Missouri, St. Louis Public Radio Morning Edition published online a PBM reform story about St. Louis-based Express Scripts being sued by the Federal Trade Commission (FTC). Pharmacists and patient advocates are advocating for lower drug prices.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nevada
The Board of Pharmacy posted the agenda for the two-day hybrid meeting in Las Vegas scheduled for October 16 and 17. On October 17 there will be a public hearing on proposed rules regarding documentation a pharmacy must obtain from a person before dispensing a controlled substance prescription.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On October 9, the Board of Pharmacy held its regular scheduled meeting. The agenda included the report of the 2024 Pharmacy Workplace Survey.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
The Office of Emergency Medical Services seeks pharmacists to assist with medical response in Western North Carolina due to Hurricane Helene. A minimum deployment of three consecutive days is preferred. If interested, sign up here and note your availability in the comments section. For questions, email OEMSSupportCell@dhhs.nc.gov.
Also in North Carolina, with Western North Carolina seeing conditions of catastrophic proportions due to Hurricane Helene, there are still many areas without power or cell service and individuals are stranded on islands due to massive road closures. If your company plans to move people, resources or equipment into western North Carolina, you must coordinate plans and movements through NCEM at BEOC@ncdps.gov and copy elizabethr@ncrma.org
Finally, the Department of Health and Human Services (DHHS) is committed to ensuring continued access to care for Medicaid beneficiaries, as well as reimbursement to qualified providers for services rendered, in good faith, throughout the period of impacts from Hurricane Helene, retroactively from September 25 through October 15 (unless otherwise communicated by DHHS).
- The Centers for Medicare & Medicaid Services (CMS) granted approval effective October 1 for DHHS to implement a temporary, expedited enrollment process for health care professionals to become a Medicaid provider due to a natural disaster. This process is not for providers who regularly see Medicaid beneficiaries.
Health care professionals who will be rendering services to Medicaid beneficiaries due to Hurricane Helene can complete and apply through the NCTracks Provider Portal. Please refer to the disaster provider enrollment job aid Disaster Relief Provider Enrollment Application Job Aid (PRV703) located under Quick Links on the NCTracks Provider Enrollment home page for necessary instructions to complete the temporary disaster provider enrollment application. Be sure to review the job aid before starting to complete the application, as several preliminary steps are necessary.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
Gainwell delivered a communication this week to notify pharmacies that the 2025 Payment Error Rate Measurement (PERM) program is now in progress. The Department of Medicaid (ODM) is mandated to participate in PERM by the Centers for Medicare and Medicaid (CMS). The program will assess payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your pharmacy will soon receive a Medical Records Request from the CMS review contractor, Empower AI. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2025: July 1, 2023, through June 30, 2024. ODM may recover payments made to providers who fail to cooperate by the established deadlines. Providers must retain recipient records for six years from the date of payment, under the terms of the Provider Agreement, even if they no longer do business with ODM. For more information about PERM, please visit the Provider link on the CMS PERM website. A video explaining the process is also available. For questions, please contact the ODM Medicaid Audit Coordination Team.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) posted a draft agenda for its October 16 meeting. Please note the discussion of “Policy recommendations for the Oregon Legislature” and SB 192 upper payment limit study. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please see the October 2024 Provider Update from Medicaid. All previous provider updates may also be found online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The Board of Pharmacy has issued guidance on the state of emergency regarding out-of-state pharmacies and emergency refills.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Gov. Bill Lee (R) issued an executive order allowing pharmacist to dispense a 30-day supply of medication (excluding controlled substances) without prior authorization for victims of Hurricane Helene. This order remains in effect until November 10. The Tennessee Pharmacy Association has compiled a list of resources and ways to support the impacted communities as relief efforts continue. Recent Department of Commerce and Insurance (TDCI) Bulletin 24-03 also provides for one early or replacement prescription refill per medication; see last bullet on page 2.
Also in Tennessee, the Tennessee Pharmacy Association requests your participation in the TennCare Diaper Program Survey. The feedback will provide data that will be shared directly with TennCare pharmacy leadership addressing reimbursement rates, administrative fees, successes and difficulties that pharmacy professionals have experienced since the diaper program launch.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Texas Pharmaceutical Initiative (TPI) Board established by HB 4990 (2023) submitted its business plan recommendations to Gov. Greg Abbott (R), the Legislature and the Legislative Budget Board on September 30. TPI’s goal is to provide greater, and more cost-effective access to prescription drugs and essential medical supplies to employees, dependents and retirees of public higher education systems; members of the Employees Retirement System of Texas (ERS); members of the Teacher Retirement System of Texas (TRS); individuals under the Texas Department of Criminal Justice or Texas Juvenile Justice Department; and individuals served by health and human services programs, including Medicaid and the Child Health Insurance Program.
Also in Texas, last month, the Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP announced that HHSC suspended its efforts to conduct pharmacy cost of dispensing and ingredient cost studies. The reason given was that “As in recent past legislative sessions, the 89th Legislature may choose to contemplate pharmacy reimbursement matters which could significantly influence how HHSC approaches and obtains necessary appropriations for pharmacy reimbursement in both fee-for-service and managed care settings.”
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts and weekly notice on the Medi-Cal Rx Web Portal:
- Pemgarda™ (pemivibart) Now a Medi-Cal Rx Benefit
- User Administration Console (UAC) URL Update
- Medi-Cal Rx Weekly Wrap-up for September 13-19
Also in California, NACDS submitted a letter to the Board of Pharmacy expressing concerns with proposed rules updating the Board’s quality assurance program regulatory requirements. The primary concern is that these amendments could potentially put pharmacies that are members of Patient Safety Organizations (PSOs) at odds with the requirements set forth in the Patient Safety and Quality Improvement Act of 2005 (PSQIA) and recommended the Board further analyze these amendments. Additionally, we requested a one-year delayed implementation of this regulation to allow pharmacies sufficient time to update their policies and systems to comply.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
The Department of Healthcare and Family Services (HFS) recently released 2023 Q4 and 2024 Q1 payments for the Critical Access Pharmacy (CAP) Program. Due to the Change Healthcare System outage earlier in the year, the Q4 data was not complete, and the Q1 data was estimated, and both will be reconciled as part of the 2024 Q2 payments once all the data from the Medicaid managed care plans has been submitted.
HFS made the estimated payments to ensure CAPs received these important funds. Please note that new pharmacies who have never received CAP funds had no estimated payment available for Q1, and therefore did not receive an initial CAP payment. HFS will also reconcile these pharmacy payments when the Q2 payments are processed.
If you have any questions, please contact a pharmacy billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
Also in Illinois, the Department informed pharmacies that the 2024-2025 influenza vaccine National Drug Codes (NDCs) have been loaded to the Pharmacy Billing Management System (PBMS) and can now be billed.
To receive the vaccine administration fee, pharmacies billing the Medicaid fee-for-service (FFS) program should enter the administration fee amount in the Incentive Amount Submitted field (438-E3). If the value in this field exceeds $6.40, the maximum allowed by the Department of Healthcare and Family Services (HFS), the claim will only pay an administration fee of $6.40. If the value of the field is less than or equal to the HFS allowed amount, the system will pay the lesser of the two. The value ‘MA’ must be entered in the Professional Service Code field (440-E5) unless no administration fee is billed. The claim will reject if it is submitted with an incorrect value in one of these fields. If a claim is submitted with an NDC for an influenza vaccine, but neither of these fields is populated, no administration fee will be paid.
For managed care organization (MCO) claims, please contact the applicable MCO for billing instructions.
Questions should be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services (HHS), Iowa Medicaid posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The latest Board of Pharmacy newsletter announced revisions to four statewide protocols effective July 24, 2024. The updated protocols include Acute Influenza Infection Chemoprophylaxis treatment, and three related to self-care, including diabetes testing and injections, over-the-counter (OTC) dietary supplements and OTC probiotics.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New York
The Office of Health Insurance Programs of the State Department of Health has approved the release of the August 2024 Medicaid Update. Included in this month’s update:
- New York State Medicaid Pharmacy Policy for Coronavirus Disease 2019 Testing
- New York State Medicaid Coverage for Coronavirus Disease 2019 Vaccines for Eligible Vaccine For Children Program Members at the Pharmacy
- Introduction to Upcoming Pharmacy and Practitioner Administered Drug Changes Due to Enacted Budget
Also in New York, on September 23, 2024, the Medicaid Program made important changes to the coverage of blood glucose testing supplies, aligning with Medicare coverage criteria. This update is designed to promote effective testing habits to support individuals managing their diabetes. Changes to the supply limits for test strips and lancets and the implications for pharmacies and healthcare providers, are explained below:
Effective October 1, 2024, the Medicaid blood glucose testing supply coverage will align with Medicare policies. The new guidelines are as follows:
- Members using insulin: Those who require insulin for blood glucose management will be eligible to receive up to 300 test strips and 300 lancets every three months.
- Members not using insulin: For individuals managing their diabetes without insulin, the allowance will be up to 100 test strips and 100 lancets every three months.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.