As two hurricanes headed for the Texas Gulf coast, earlier this week Governor Greg Abbott declared a disaster in multiple counties which automatically triggered emergency procedures for dispensing of medications. Additional information on the declared state of emergency can be found here.

Also in Texas.  The Department of Insurance, Division of Workers’ Compensation issued an emergency rule waiving certain CMS distant site practitioner requirements during the COVID-19 outbreak that would allow health care providers licensed to perform physical medicine and rehabilitation services to bill and receive reimbursement for services allowed under current CMS telemedicine and telehealth billing codes.  Under this emergency rule, these waivers will be extended until October 9, 2020.

Also in Texas. The Health and Human Services Vendor Drug Program (VDP) issued three announcements:

1. Opioid-Related Clinical Prior Authorization Criteria Updates – VDP regularly updates clinical prior authorization criteria to better align drug policies and prior authorization approval criteria with the latest information available on drug information packets, the federal or state regulations. Opioid-related prior authorizations are scheduled for revision on September 1, 2020, to align with the uniform opioid policy.
2. Insulin Products Return to Non-Preferred Status – VDP temporarily removed the non-preferred status on April 1 in response to reported drug shortages for insulin products in the “Hypoglycemics, Insulins” drug class. VDP will reverse this change in status because of sufficient availability in the market. Beginning September 18, 2020, the Medicaid formulary will reflect the Preferred Drug List status changes for all non-preferred insulin products.
3. Inhaled Glucocorticoids Products Return to Non-Preferred Status – VDP temporarily removed the non-preferred status on April 1 in response to reported drug shortages for medications in the “Glucocorticoids, Inhaled” drug class. VDP will reverse this change in status because of sufficient availability in the market. Beginning September 18, 2020, the formulary will reflect the Preferred Drug List status changes for all non-preferred inhaled glucocorticoid products.

Also in Texas. On September 1, 2020, the Health and Human Services Commission (HHSC) will expand the Medicaid and CHIP benefit to allow and reimburse pharmacists for administering certain medications in a pharmacy setting, including the administration of certain long-acting anti-psychotics, opiate dependence treatments and emergency treatment for known or suspected opioid overdoses, and flu vaccines.  Under this benefit, pharmacies must be reimbursed for the ingredient cost, administration fee, and applicable dispensing fee for each claim processed. Pharmacies will also be reimbursed for the administration of flu vaccines for ingredient cost and the administration fee. To prepare pharmacies for changes to the claims submission process an addendum (PDF) to the NCPDP B1 Transaction Billing Request Payer Sheet is available showing changes to three existing fields in the Drug Use Review/Professional Pharmacy Service segment and addition of one new field to the Pricing segment. Pharmacies should refer to the addendum for more information on how this change impact claims processing. VDP will revise the full B1 payer sheet upon implementation. More information can be found here.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

To advance our 2021 legislative agenda, NACDS and the Texas Federation of Drug Stores continue to schedule virtual meetings with lawmakers, advocating for increased access to immunizations (including the future COVID-19 vaccine), expanded pharmacists scope of practice, and fair Medicaid reimbursement. In support of these initiatives, NACDS and pharmacists from HEB and Walgreens that live and work key districts recently met with Senator Kelly Hancock (R) (Chair of the Business and Commerce Committee), Representative Geanie Morrison (R), Representative Julie Johnson (D), Representative John Kuempel (R), and Representative Eddie Lucio III (D).

Also in Texas. On September 15^th , the Health and Human Service Commission Vendor Drug Program will extend the non-preferred prior authorization duration for macrolides from 30 days to 90 days for people with a diagnosis of Gastroparesis, Cerebral Palsy Gastroparesis, or GERD Gastrostomy complications. Managed Care Organizations are required to comply with this PDL prior authorization criteria, including duration. More information can be found here.

For more information, contact NACDS’ Mary Staples at 817-442-1155.