North Carolina
Beginning July 1, North Carolina will transition from a fee-for-service Medicaid program to Managed Care. More information on this transition can be found here. You may also find the June 16, 2021, Managed Care Transformation update for pharmacy stakeholders presentation here. Of note, 90-day fills and mail and delivery fees from local/community pharmacies, which were flexibilities granted during the COVID State of Emergency have been made permanent. Also Slide 18 on the presentation contains important Medicaid billing updates.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Pennsylvania
Last week, the General Assembly voted to terminate the Governor’s disaster declaration. Both chambers then subsequently passed legislation, which Governor Wolf (D) signed, that extends all statutory and regulatory waivers until September 30, 2021. We anticipate further legislative action in the fall related to the continuation of some waivers and flexibilities beyond September 30 and will continue to update members on those efforts.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
The Centers for Medicare and Medicaid Services (CMS) has informed the South Carolina Department of Health and Human Services (SCDHHS) that the South Carolina Healthy Connections Medicaid program will participate in the Payment Error Rate Measurement (PERM) program for State Fiscal Year 2022. CMS’ PERM program was developed to measure the accuracy of Medicaid and Children’s Health Insurance Program (CHIP) payments made by states. Each state is reviewed once every three years. Samples of claims with paid dates of July 1, 2021, through June 30, 2022, will be subject to review. You can review the entire bulletin here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
NACDS continues to strongly advocate, through social media messaging and pharmacists contacting Gov. Greg Abbott (R) before Sunday, June 20, 2021, that the governor sign into law HB 1919, legislation that would help maintain patients’ right to choose a pharmacy provider by prohibiting health benefit plans and pharmacy benefit managers from “steering” patients to use any in-network pharmacy provider over another.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Stakeholders were recently made aware that at least one PSAO has sent communications to its pharmacy members that it would begin charging sales tax on its services in June. The Alabama Department of Revenue (DOR) has confirmed that the collection of sales taxes for PSAO services is not in compliance with the sales tax law. The DOR further stated that if additional PSAOs attempt to collect sales tax for their services, pharmacies should contact the DOR to resolve the issue.
Also in Alabama, the Board of Pharmacy has proposed the below rules.
- Proposed rule of the Board of Pharmacy would amend regulations under AAC 680-X-2 to replace “inspectors” with “investigators” in the provisions on revealing sources of information related to violations. A hearing is scheduled for July 21, 2021, in Birmingham. Comments are due July 10, 2021.
- Emergency rule of the Board of Pharmacy adopts regulations under AAC 680-X-2 to allow the board to issue temporary pharmacist practice permits during the coronavirus (Covid-19) public health emergency. The rule applies to applicants licensed in another state who meet specified criteria. The rule readopts the April 30, 2020, emergency rule and became effective April 28, 2021, and expires August 26, 2021.
- Proposed rule of the Board of Pharmacy would repeal and readopt regulations under AAC 680-X-2 to update the physician and pharmacist collaborative practice requirements. A hearing is scheduled for July 21, 2021, in Birmingham. Comments are due July 10, 2021.
- Proposed rule of the Board of Pharmacy would amend regulations under AAC 680-X-2 to include supervising pharmacists and technicians in the disciplinary provisions for violation of the pharmacy technician training requirements. A hearing is scheduled for July 21, 2021, in Birmingham. Comments are due July 10, 2021.
- Proposed rule of the Board of Pharmacy would amend regulations under AAC 680-X-2 to revise requirements for registered pharmacists to notify the board of a change of supervising pharmacist. A hearing is scheduled for July 21, 2021, in Birmingham. Comments are due July 10, 2021.
- Emergency rule of the Board of Pharmacy amends regulations under AAC 680-X-2 to allow pharmacists to provide emergency prescription refills for a 30-day supply of maintenance medications under certain circumstances during the COVID-19 public health emergency. The rule readopts a March 31, 2020, emergency rule and became effective April 21, 2021, and expires August 26, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arkansas
The Department of Human Services issued two new proposed rules:
- Proposed rule amending Medicaid provider regulations to remove references to the Arkansas Foundation for Medical Care, Inc. as the vendor used for approval, denial, or extension of Medicaid benefits.
- Proposed rule amending regulations to revise the Pharmacy Provider Manual to update the Place of Service Code to “01,” effective for dates of service on August 1, 2021.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The State Board of Pharmacy published its agenda for the June 17, 2021, teleconference public board meeting that includes discussion and consideration of adoption of board approved regulation, Section 1717.5 related to automatic refill program, and discussion and consideration of public comments received during the 15-day comment period on the proposed new modifications to the regulation.
Also in California, the Department of Managed Health Care released an All Plan Letter 21-016 to provide information and guidance on when health care service plans must cover COVID-19 diagnostic testing. The letter specifies that health plans must continue to cover testing as required by federal law and guidance that is still in effect and to refer to COVID-19 testing guidance issued by the California Department of Public Health.
Lastly in California, the Board of Pharmacy issued a notice amending regulations under 16 CCR 1715.6 to revise drug loss reporting requirements to establish a minimum reporting threshold and align with federal standards. Hearing requests are due July 5, 2021, and comments are due July 19, 2021
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
District of Columbia
Mayor Muriel Bowser (D) signed B24-257 to allow emergency refills under certain conditions. The bill was introduced and passed as a “gap filler” between the expiration of the previous emergency amendment act, B24- 139, and B24-140 as it will be under Congressional Review for another 2 weeks before becoming law.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Florida
Effective October 1, 2021, any fee-for-service (FFS) claim submitted with a National Provider Identifier (NPI) for a provider not enrolled with Florida Medicaid will be denied, and the provider will not receive reimbursement for services. This includes claims that list a Referring, Ordering, Prescribing, or Attending (ROPA) provider. ROPA providers must be enrolled with Florida Medicaid following Title 42, Code of Federal Regulations, Section 455.410(b). Starting October 1, 2021, claims will not be paid for any practitioner, group practice, facility, or pharmacy providing services to Florida Medicaid recipients based on a ROPA provider’s referral, order, prescription, or attending services, unless the ROPA provider identified by NPI on the FFS claim is actively enrolled with Florida Medicaid.
Florida Medicaid features a quick and easy, automated ROPA provider enrollment application on the Florida Medicaid Web Portal Enrollment Application Wizard page. Please visit the ROPA Provider Enrollment page of the Web Portal for updated information, including the recently created Unenrolled ROPA Provider List, ROPA Providers Frequently Asked Questions, and Quick Reference Guides on ROPA provider enrollment and claims billing. Providers may call the Provider Services Contact Center at 1-800-289-7799, option 7, for billing assistance and option 4 for enrollment assistance.
Also in Florida, the Department of Business and Professional Regulation has proposed the below rules.
- Proposed rule of the Department of Business and Professional Regulation would amend regulations under FAC 61N-1 regarding drug and device labeling requirements to revise the references to federal regulations incorporated by reference. Comments and hearing requests are due June 28, 2021.
- Proposed rule of the Department of Business and Professional Regulation would amend regulations under FAC 61N-1 to update the application forms incorporated by reference for permits to be a diethyl ether manufacturer, distributor, dealer, or purchaser. Comments and hearing requests are due June 28, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Louisiana
The Board of Pharmacy recently approved several rules effective May 20, 2021.
- Final rule increases the amount of medication that may be dispensed under an emergency prescription to a 90-day supply. The rule also provides for special permitting of pharmacists licensed outside the state to allow participation in disaster relief.
- Final rule establishes standards for licensure of pharmacy benefit managers engaged in certain activities. The rule establishes procedures for board review of applications for the initial issuance of the permit, the renewal of the permit, applications for the reinstatement of disciplined permits, and the permanent closure of a permit.
Also in Louisiana, the Department of Health (LDH) is reviewing the current transportation services and pharmacy benefit delivery models for its Medicaid managed care program. LDH is seeking input by June 21, 2021, on the key factors that must be considered when improving these models. This feedback can be provided at: https://ldh.la.gov/index.cfm/form/241.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Minnesota
The Department of Health expects to issue guidance on how to comply with the Prescription Drug Price Transparency Act by early summer 2021, which will include technical definitions and reporting requirements for the act. MDH will share information related to the act’s implementation and opportunities for public feedback on this page, through GovDelivery bulletins, and via State Register announcements. Stakeholders interested in receiving announcements on implementation of the act may subscribe to Prescription Drug Price Transparency updates.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Mississippi
The Division of Medicaid has issued the below final rules.
- Final rule of the Division of Medicaid amends regulations under Title 23, Part 224, Chapter 1 to set the fees for immunizations to those in effect for the state fiscal year 2021. The rule is effective July 1, 2021.
- Final rule of the Division of Medicaid amends regulations under Title 23, Part 200, Chapters 1, 3, and 4 to increase to 90 days the time period for providers to request an administrative review for claims. The rule also revises beneficiary cost-sharing and 340B provider requirements to comply with federal standards. The rule is effective July 1, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Missouri
Gov. Mike Parson (R) signed SB 63 into law, which makes it the 50th state to create a statewide prescription drug monitoring program. The bill establishes the Joint Oversight Task Force of Prescription Drug Monitoring, responsible for collecting and maintaining the prescription and dispensation of prescribed controlled substances to patients within the state. It also extends the expiration date of the RX Cares for Missouri Program to August 28, 2026.
Also in Missouri, the Department of Social Services, MO HealthNet Division, issued two new proposed rules requesting comments by July 1, 2021. Both are currently in effect as emergency rules expiring February 24, 2022.
- Proposed rule removes obsolete provisions and references new provisions establishing the payment methodology for covered entities under the 340B drug pricing program that choose to carve in Medicaid.
- Proposed rule establishes the payment methodology for covered entities under the 340B drug pricing program that chooses to carve in Medicaid.
Also in Missouri, the Board of Pharmacy issued a final rule effective June 30, 2021, removing the limit on the number of intern pharmacist practice hours that may be earned per week.
Also in Missouri, the Department of Commerce and Insurance issued a proposed rule to establish the license application process and a $1,000 application fee for pharmacy benefit managers. The rule replaces a September 15, 2020, proposed rule. Comments are due on June 16th, and a public hearing will be held on June 17, 2021.
Also in Missouri, the Board of Pharmacy is soliciting comments on two proposed rules:
- Proposed rule rescinds regulations regarding pharmacy operating procedures during declared disasters. A concurrent proposed rule would readopt the provisions to address both disasters and state/federal emergencies. Comments are due June 16, 2021.
- Proposed rule adopts regulations establishing guidelines for temporary pharmacy operations during an emergency or declared disaster. The rule would replace pharmacy disaster operation procedures that are proposed for repeal concurrently.
Also in Missouri, the Board of Pharmacy recently approved two final rules 20 CSR 2150-5.025 and 20 CSR 2220-6.050 which allows pharmacy technicians to administer vaccines under the supervision of a state-licensed pharmacist according to a written protocol with a licensed physician who is actively engaged in the practice of medicine. The rule is issued in response to the COVID-19 pandemic effective July 30, 2021.
Lastly in Missouri, the Department of Social Services, MO HealthNet Division issued three final rules effective July 30, 2021.
- Final rule adds an exception to the 31-day supply maximum restriction on medications reimbursed by the division on behalf of participants eligible for the fee-for-service programs, and an exception to allow for a 90-day supply requirement for select medications established in a concurrent rule. The rule also replaces references to “recipient” and “patient” with “participant.”
- Final rule adopts a 90-day supply requirement per dispensing on select medications reimbursed by the division on behalf of participants eligible for Medicaid fee-for-service programs.
- Final rule revises the amount of the professional dispensing fee reimbursable for MO HealthNet covered prescriptions by pharmacy providers.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
SB 395 Chapter Number: 501, establishing licensure, reporting, marketing, and advertising, network adequacy requirements, and 340B related provisions for PBMs, was signed by Gov. Greg Gianforte (R) on May 12, 2021.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
Effective July 1, 2021, the METAVIR fibrosis score required for coverage by Nebraska Medicaid will be changed to F0. The current prior authorization criteria require a METAVIR fibrosis score of at least F2. These changes mean that patients with a METAVIR fibrosis score of F0 may have their prescribed antiviral medications to treat hepatitis C be covered by Nebraska Medicaid. Prior authorization for Hepatitis C antiviral medications will continue to be in place. See Provider Bulletin 21-11 for additional details.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
This week the full Senate passed their budget bill by a party-line vote. The passed version appropriates $5 million for Fiscal Year 2022 and $10.15 million for Fiscal Year 2023, plus Federal Medical Assistance Percentages to fund the Managed Care Supplemental Dispensing Fee. NACDS worked in partnership with the Ohio Council of Retail Merchants to advocate that funding for this program continue. It is not included in the competing versions of the budget as proposed by the Governor and the House. We will continue to champion this line item as budget negotiations continue over the next two weeks.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
HB 2677, amending the audits and administrative appeals procedures, was signed by Gov. Kevin Stitt (R) on May 4, 2021.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
South Carolina
The Board issued several emergency orders to allow for the safe and effective care of patients during an unprecedented pandemic. The Board has continually reviewed these orders and made adjustments as necessary. Effective July 1, 2021, all Board-issued emergency orders are scheduled to be rescinded. Please begin planning now. Those orders pertain to Safe Harbor regarding the reuse of personal protective equipment, pickup kiosks, and remote order entry outside of a licensed facility. Those orders can be here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
NACDS sent a letter to Gov. Greg Abbott (R) urging him to sign HB 1919 into law, legislation that would help maintain patients’ right to choose a pharmacy provider by prohibiting health benefit plans and pharmacy benefit managers from “steering” patients to use any particular in-network pharmacy provider over another. In addition, we have been urging member companies to also contact the Governor’s office.
Also in Texas, the Board of Pharmacy hired a new Executive Director/Secretary Tim Tucker, Pharm.D., replacing Allison Benz who announced earlier this year that she would be retiring on August 31, 2021. The Texas press release can be found here.
Also in Texas, the Board of Pharmacy adopted several rules that became effective June 9, 2021.
- Final rule extends the time that Schedule II prescriptions are valid to 30 days to conform to federal standards and removes a reference to the effective date of the pharmacy responsibility provisions.
- Final rule allows pharmacists to electronically sign the data entry attestation statement. The rule also updates references to the DEA 222 order form requirements for distributing Schedule II controlled substances.
- Final rule extends the time that Schedule II prescriptions are valid to 30 days to conform to federal standards.
- Final rule corrects statutory and regulatory cross-references in the requirements on pharmacy operation.
Also in Texas, the Health and Human Services Commission has several COVID-related upcoming weekly seminars now open for registration.
- Webinar Tuesdays: Actively Administering & Advanced VAOS Users: For COVID-19 vaccine coordinators and providers who have received an order of the COVID-19 vaccine and are actively administering the vaccines. The state will share important news updates, clinical considerations, and advanced user tips on the systems and processes to support you.
- Webinar Thursdays: Basics & Beginners: For providers who are new to the COVID-19 vaccine management program and/or have not yet received an order of the vaccine. We discuss important news updates, how to access VAOS, and how to get started with placing orders.
- June 17, 12:00PM-1:30PM CT – Register here
- June 24, 12:00PM-1:30PM CT – Register here
Lastly in Texas, the Health and Human Services Commission (HHSC) will resume publication of the quarterly Specialty Drug List in July. Please see the stakeholder notice.pdf for more information
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Health Care Authority issued a final rule changing the time frame in which manufacturers must report new drugs marketed in the state and incorporate the prescription drug pricing transparency program’s nondisclosure agreement.
Also in Washington, effective July 1, 2021, Apple Health (Medicaid) which is administered by the Health Care Authority (agency) will implement changes to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program. Please view the MAC memo for more details. Additionally, the full SMAC list can be found on the agency’s Provider billing guides and fee schedules website under the Prescription Drug Program and applies to claims billed FFS.
Also in Washington, effective for claims with dates of service on and after July 1, 2021, Apple Health (Medicaid) updated the pharmacy Expedited Authorization (EA) List. On the Provider Billing Guides and Fee Schedules Page, scroll to Prescription Drug Program Billing Guides to access.
Also in Washington, the Office of the Insurance Commissioner issued a notice extending the Emergency Order 20-01 requiring health insurers to waive copays and deductibles for COVID-19 testing. The order also requires insurers to allow a one-time early refill for prescription drugs, suspends any prior authorization requirement for treatment or testing of COVID-19, and allows enrollees to be treated by out-of-network providers within a reasonable distance at no additional cost when the insurer does not have enough in-network medical providers.
Lastly in Washington, the Department of Health issued a final rule effective June 18, clarifying dispensers must submit information to the prescription monitoring program as soon as possible, but no later than one business day. The rule also removes the requirement that a facility or entity be a trading partner with the state’s health information exchange to have access to the prescription monitoring program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
The Board of Health published a notice to announce the removal of the opioid antagonist samidorphan from Schedule II of the Controlled Substances List attached to regulations under AAC 420-7-2. The action is a response to the federal Drug Enforcement Administration removing the substance on April 19. The action is effective May 19, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
HB 145, modernizing the pharmacy practice statutes, passed both the House Labor and Commerce Committee and the House Health and Social Services Committee earlier this year and will carry over and remain active for consideration as 2021-2022 continues next year. The bill defines patient care activities pharmacists may provide and empowers the Board of Pharmacy to regulate those services; empowers the Board of Pharmacy to more effectively regulate pharmacy support staff; and supports reimbursement for health care services by defining those services and including pharmacists in the state’s provider anti-discrimination statute.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
On May 30, Gov. Asa Hutchinson (R) officially ended the public health emergency which has been in place since March 11, 2020.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Medi-Cal Rx Monthly Bulletin dated June 1, 2021, includes a summary of previously shared updates and serves as a reminder of upcoming changes, deadlines, and opportunities as outlined below:
- Changes to the Contract Drugs List, Effective June 1, 2021
- Medi-Cal Rx Training Information
- UAC Registration Troubleshooting
- Medi-Cal Rx UAC Application Roles
- Provider Registration and FAQs
- Medi-Cal Rx Transition and Resources Training
Also in California, the Department of Health Care Services (DHCS) delayed the planned Go-Live date for Medi-Cal Rx. On May 28, 2021, DHCS posted an update for providers and will continue to communicate additional information as it becomes available.
Also in California, the Medi-Cal Update Bulletin 992 – May 2021 includes updates to the List of Enteral Nutrition Products, effective for dates of service on or after July 1, 2021, and various provider manual updates. See bulletin for additional information.
Also in California, on May 27, 2021, the DUR Board Meeting Minutes for February 23, 2021, were posted to the DUR: Board Meetings page of the Medi-Cal website.
Also in California, as the June 30 end of the fiscal year approaches, the Board of Pharmacy expects a delay in processing payments for license renewals submitted by mail during the last week of June and the first week of July and provided guidance to licensees.
Lastly in California, the Office of Administrative Law approved regulations regarding automated drug delivery systems and off-site storage of records that take effect July 1, 2021.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The State Board of Pharmacy announced a virtual Stakeholder Meeting on June 14th to receive feedback on Notice, Draft Rules, SB21-011, SB21-094, SB21-122, and SB21-123.
- Potential rule changes related to Colorado Senate Bill 21-011 (Concerning responsibilities of a pharmacist related to opiate antagonists);
- Potential rule changes related to Colorado Senate Bill 21-094 (Concerning implementing recommendations contained in the 2020 sunset report that make changes regarding the practice of professions regulated by the Board);
- Implementing Colorado Senate Bill 21-122 (Concerning the bulk purchase of opiate antagonists according to a standing order);
- Implementing Colorado Senate Bill 21-123 (Concerning expanding the Canadian prescription drug importation program); and
- New and revised rules are recommended by the Board and stakeholders to provide clarity and a general cleanup of the rules.
To register in advance, go to Webinar Registration. Written comments should be sent by June 10th to – dora_dpo_rulemaking@state.co.us.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.