Kentucky
As of June 29, 2021, pharmacies will not have to obtain identification for a patient person purchasing hypodermic syringes and needles or maintain a logbook for these purchases. The change is a result of the passage of HB 219 of 2021. The new law also details the conditions under which pharmacies may sell syringes without a prescription, including providing written or electronic materials on safe disposal and syringe exchange programs and offering the patient Naloxone. Lastly, the law clarifies that syringes sold under these provisions do not constitute drug paraphernalia.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
In response to a survey from the Louisiana Department of Health (LDH), NACDS submitted comments recommending ways LDH can improve the pharmacy benefit delivery models used by the state’s Medicaid managed care organizations. Specifically, NACDS suggested that they adopt policies to help ensure patient access to neighborhood pharmacies by promoting the ability for any willing pharmacy to participate in a managed care organization’s network provided that a pharmacy accepts the terms and conditions of that network. We also advocated that LDH carve out the prescription drug benefit from the Medicaid managed care program to the state’s fee-for-service program. Lastly, we recommended the adoption of a Medicaid managed care reimbursement methodology that seeks to ensure a pharmacy’s costs are covered, which aligns with methodology used under the state’s Medicaid fee-for-service program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
As a result of Gov. Larry Hogan’s (R) termination of the State of Emergency that will be effective July 1, 2021, the Department of Health’s Office of Pharmacy Services announced they will rescind the waiver allowing pharmacies to deliver without a receiver signature. Therefore, effective August 15, 2021, the Medicaid Fee-for-Service Program will require pharmacies to record signatures when delivering prescriptions.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
Now that the Massachusetts State of Emergency has been lifted, the Department of Public Health has issued several regulatory updates.
Therefore, effective June 30, 2021, the Board will return to the following pre-pandemic requirements:
- 12 hour workday maximum (247 CMR 6.02(9)(c))
- supervisory ratios (247 CMR 8.06(3))
- perpetual inventory every 10 days (247 CMR 9.01(14))
- compounding copies of commercially available drugs
- restocking emergency kits in long term care facilities within 48 hours (105 CMR 150.008(E))
- ID requirement for picking up a federally controlled substance or gabapentin prescription (105 CMR 700.012)
- NOTE: ID is not needed to pick up prescriptions for federally scheduled controlled substance in certain circumstances. However, the individual must print his or her name and address on the reverse side of the prescription and sign it. In the case of an electronic prescription, they must provide an electronic signature. Review the Data Submission Dispenser Guide for details.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Missouri
Gov. Mike Parson (R) convened a special session on June 23, 2021, to address extending Medicaid funding for the state because the Legislature adjourned last month prior to passing a renewal of the Federal Reimbursement Allowance (FRA), the tax on health care providers that draws down billions in federal matching dollars to fund the state's Medicaid budget. To prevent a $1.4B budget gap, lawmakers only have five days to pass legislation to extend the program as the deadline for a balanced state budget is set for July 1, 2021.
Also in Missouri, NACDS is preparing a comment letter objecting to an emergency proposed rule that would add this new definition of usual and customary ("U&C") for purposes of reimbursement for covered drugs under the state's Medicaid program. "U&C is defined as the provider's charge to the general public that reflects all advertised savings, discounts, special promotions, or other programs including membership-based discounts initiated to reduce prices for product costs available to the general public, a special population, or an inclusive category of customers."
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
Below are highlights from the June issue of the New Mexico Board of Pharmacy newsletter. See the newsletter for additional details and more information.
- As some prescribing practitioners are working to implement the electronic prescriptions for controlled substances requirement that was effective April 1, 2021, the Board issued an "Emergency Dispensing Declaration" from April 1, 2021, through June 30, 2021, and it does not intend to take action against a pharmacist who fills a nonelectronic controlled substance prescription not otherwise subject to the exceptions.
- Effective June 18, 2021, a healthcare provider may provide a prescription for medical aid in dying to a terminally ill adult who is mentally competent after meeting certain requirements pursuant to HB 47, the Elizabeth Whitefield End-of-Life Options Act
- REMINDER: Be Sure to submit Adverse Drug Event reports to the Board within 15 days as required by regulation.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
Gov. Andrew Cuomo (D) announced that the NYS COVID-19 Emergency Declaration expires after June 24, 2021. In response, NACDS sent a letter urging the Governor to recognize the authority of the federal PREP Act to insure a continuity of care for New Yorkers needing COVID vaccinations and tests. As a reminder, today pharmacists have the ability to give COVID-19 vaccines to those aged 12 years and older pursuant to NYSDOH guidance which recognizes this provision in the federal PREP Act. This guidance also speaks to vaccine reporting to NYSIIS/CIR and other related requirements.
In addition, NACDS wrote Gov. Cuomo a letter in support of SB 4807A, legislation which will authorize pharmacists to immunize patients 18 years of age and older for all CDC approved vaccines. The Governor has until December 31, 2021, to sign this proposal into law.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Dakota
Below are highlights from the June issue of the North Dakota Board of Pharmacy newsletter. See the newsletter for additional details and more information.
- Signed on March 22, 2021, by Gov. Doug Burgum (R), SB 2221 includes three key provisions including
- lowering the age for immunizations and vaccinations to at least three years of age upon an order from a prescriber or by written protocol with a physicians or nurse practitioner;
- permitting a pharmacist to bill for dispensing a one-time emergency refill of up to a 30-day supply of the prescribed medication under certain conditions and
- defining “public health issues” and establishing limited prescriptive authority through a statewide protocol for public health issues within the pharmacist’s scope of practice with the Board of Pharmacy adopting rules to establish standards of care.
- SB 2294, legislation increasing the retail sales quantity from 2 grams to 2.4 grams of ephedrine, pseudoephedrine, or phenylpropanolamine base, was signed by Gov. Doug Burgum (R) on March 23, 2021. This new law is effective August 1, 2021. The 30-day sales limit remains unchanged.
- SB 2279, permitting the Board of Pharmacy to adopt rules to establish requirements to allow a pharmacy technician to administer a drug under the immediate supervision of a pharmacist, was signed on March 25, 2021. The Board is preparing to initiate the rulemaking process to operationalize this for current registered technicians who have completed the requirements and meet the standards the Board outlines.
- Please note section on “Immunization and Medication Administration Guidance” that includes the two ways pharmacists and interns may update and maintain “administration authority” on their license.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
HB 193, legislation requiring electronic prescribing for Schedule II controlled substances, has been amended and passed unanimously by the House of Representatives. The amendment added language from NACDS’ model legislation that would hold pharmacies harmless when filling legitimate non-electronic prescriptions. The amendment was a result of joint advocacy by NACDS and the Ohio Council of Retail Merchants to align the bill with our model language and the Medicare law. Further action in the Senate is expected in the fall.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
Effective June 15, 2021, the Board of Pharmacy amended the following regulations:
- OAR 855-007 to allow pharmacists at immunizing clinics to supervise as many state-licensed immunizing interns as they determine will maintain public health and safety during a declared public health emergency. The rule is response to the coronavirus (COVID-19) pandemic.
- OAR 855-041 to remove the limit on epinephrine dispensed to an entity to allow maintenance of epinephrine at coronavirus (COVID-19) vaccination locations.
- OAR 855-019, -021, -025 and -031 to incorporate cultural competency continuing education requirements for pharmacists, pharmacy technicians and pharmacy interns.
- OAR 855-020 to update the statewide drug therapy management protocols in the formulary and protocol compendia.
- OAR 855-001 and -041 to revise requirements for inspection of drug outlets, including performance by the Compliance Officer, and for pharmacy records.
- OAR 855-110 to revise the late fee expiration dates for licensees and registrants.
- OAR 855-080 to ensure clarity, transparency and promote patient safety related to controlled substances.
- OAR 855-006 and repeals regulations under OAR 855-050 to remove outdated restrictions on retail drug sales and make a confirming change to incorporate the definition of “prescription drug.”
- OAR 855-041 to clarify requirements for pharmacies related to Drug Take Back Programs.
Also in Oregon, on June 15, 2021, Gov. Kate Brown (D) signed HB 2648, removing the existing prescription only requirement for purchases of pseudoephedrine (PSE) containing medications and instituting the National Precursor Log Exchange (NPLEx) in its place. As a result of this newly enacted law, Oregon becomes the 37th state to mandate the use of NPLEx, and no state will require a prescription for the purchase of a Food and Drug Administration (FDA) approved over-the-counter product containing PSE. NACDS acknowledges the efforts of CHPA to support this repeal over the last several years.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
Effective July 1, 2021, the South Carolina Department of Health and Human Services' Program Integrity Unit (PI) announced it will resume onsite visits for provider reviews.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
A proposed rule of the Department of Mental Health and Substance Abuse Services would repeal and readopt regulations under RRT 0940-06-01 to update standards on controlled substances. The rule would include the schedules of controlled substances and lists of certain non-narcotic substances, chemical preparations, prescription products, anabolic steroids and cannabis products that are excluded from the schedules. A hearing is scheduled for August 2, 2021, in Nashville. Comments are due August 12, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
On June 18, 2021, Gov. Greg Abbott (R) chose to let House Bill 1919 become law. Rep. Cody Harris (R) and Sen. Charles Schwertner's (R) bill will help maintain patients' right to choose a pharmacy provider by prohibiting health benefit plans and Pharmacy Benefit Managers (PBM's) from directing patients to use any particular pharmacy provider over another and prohibiting PBMs from exclusively requiring the purchase of pharmacy services through a certain mail-order pharmacy or imposing a monetary advantage or penalty under a health benefit plan that would affect a patient's choice of pharmacy. The law becomes effective September 1, 2021.
Also in Texas, Gov. Abbott (R) announced that he will be convening a special session of the legislature on July 8, 2021. The Governor did not disclose what legislative priorities will be included on the special session agenda, only that such items "will be announced prior to the convening of the special session."
Finally in Texas, the Board of Pharmacy's Prescription Monitoring Advisory Committee held a virtual quarterly meeting on June 16th to discuss funding issues and operational improvements to the Prescription Monitoring Program (PMP). HEB's pharmacist Doug Read serves as the chain representative on the Advisory Council. The state's vendor Appriss presented the NarxCare version 2.0 program. More information is available at Texas Prescription Monitoring Program (PMP).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
Gov. Jay Inslee (D) announced that the Washington State Health Care Authority, Apple Health (Medicaid) established provisions to make proactive vaccine counseling visits to their patients a reimbursable service to the provider effective June 28, 2021. To take advantage of this new billable service, go to – Apple Health COVID-19 vaccine billing policy
Also in Washington, due to the timing of the State Fiscal Year End and the Independence Day holiday, provider payments for the week of June 28, 2021, will be made on July 7, 2021. Claim submission deadlines were updated to ensure that providers can receive payment and RA documents on July 7, 2021. The deadline for claim submissions to ProviderOne to receive payment on July 7, 2021, will be 4 p.m. on July 1, 2021. The deadline for pharmacy claim submissions to the Point of Sale (POS) to receive payment on July 7, 2021, will be 6 p.m. on Wednesday, June 30, 2021. Report any issues to: mmishelp@hca.wa.gov
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
A Final rule of the Board of Pharmacy amends regulations under AAC 680-X-2 to clarify provisions on the non-disciplinary administrative penalty for late renewal of a license, permit, registration, certification, or similar document. The rule is effective July 12, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
NACDS and the California Retailers Association submitted a joint letter to the Senate Budget Committee and the Senate Budget & Fiscal Review Committee in support of Gov. Gavin Newsom’s (D) May Revise budget proposal to provide medication therapy management payments to the Department of Health Care Services’ contracted pharmacies dispensing specialty drugs and services to Medi-Cal beneficiaries and urged its passage.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
NACDS, the Colorado Retail Council, and the Colorado Pharmacy Society supported legislation that would modernize pharmacists' scope of practice to include prescribing medications for self-limiting conditions, ordering and analyzing lab tests, and performing minor physical evaluations, which passed both housed and was sent to Gov. Jared Polis (D) on June 11th to sign into law. (SB21-094)
Also in Colorado, NACDS participated in the Colorado Department of Regulatory Agencies' (DORAs') Division of Professions and Occupations State Board of Pharmacy stakeholder meeting this week. DORA received input on potential rule changes on implementing several bills passed by the legislature including pharmacists' and pharmacy technicians' scope expansion that Gov. Jared Polis (D) is expected to sign into law, and clean-up and clarification of existing rules. NACDS will engage with the Board of Pharmacy as the formal rulemaking process moves forward later this summer.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
District of Columbia
Pharmacists will be able to provide and bill for substance abuse disorder services beginning July 1 under Medicaid’s new District Addiction Consultation Services (DACS) program. More information will be available soon on this webpage by clicking on “Provider Portal” then “Quarterly Pharmacy Forum” under the “Frequently Requested Documents” tab and choosing the June meeting PowerPoint presentation.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Florida
The Board of Pharmacy issued a Final rule to repeal regulations under FAC 64B16-28 to remove outdated requirements for automated pharmacy systems in community pharmacies. The rule is effective June 24, 2021.
Also in Florida, the Board of Pharmacy issued a Final rule to amend regulations under FAC 64B16-28 to increase to 120 days the maximum beyond-use date requirement for labels of customized patient medication packages. The rule also requires pharmacies using customized patient medication packages to have policies and procedures addressing patient medication regimens. The rule is effective June 24, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
Gov. Eric Holcomb (R) signed Executive Order 21-14 to extend the public health emergency to June 30 and Executive Order 21-15 to adjust COVID-19 requirements effective June 1st. Each directive from executive orders continued throughout the public health emergency will cease on June 30th. The following directives relating to pharmacy practice will no longer be in effect:
- EO 20-05: Suspended the requirement that a healthcare provider holds an Indiana license if he or she: (1) has an equivalent license from another State, and (2) is not suspended or barred from practice in that State or any State. Authorized the head of any state agency (including PLA) to waive, suspend, or modify any existing rule where the enforcement of which would be detrimental to the public welfare during the emergency.
- EO 20-12: Non-controlled substances as maintenance medications permitted a one-time 90-day emergency refill.
- EO 20-13: Retired health care professionals who, within the past 5 years, retired or surrendered their license, may provide health care services in Indiana without reinstatement or approval by the relevant license board.
- EO 20-21: Pharmacy students who have completed all required course work, applied for a pharmacist license, and supplied a certificate of completion, may practice as a pharmacist without first taking and passing the MPJE and NAPLEX.
- EO 20-27 and 20-31: Any license set to expire during the public health emergency is extended for the duration of the public health emergency.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
Gov. Kim Reynolds (R) sent a letter to Paul Pate, Secretary of State of Iowa, directing the Department of Human Services to amend current Medicaid managed care contracts to authorize a $10.38 dispensing fee per prescription across-the-board for all pharmacies under Section 31 of HF 891. This action is in response to a meeting and letter NACDS sent to the Governor requesting a veto of language in HF 891 directing the department to amend Medicaid managed care organization contracts to authorize the establishment of a managed care pharmacy dispensing fee that is based on the current fee-for-service dispensing fee of $10.38 or a dispensing fee that is not to exceed the current fee-for-service rate and determined contractually by mutual agreement between the managed care organization and a participating pharmacy with more than 30 locations in the state and headquarters outside the state. The Governor agreed with industry stakeholders that this policy creating differential dispensing fees for certain pharmacies raises significant constitutional concerns. NACDS acknowledges the collaborative efforts of the Iowa Retail Federation and the Iowa Pharmacy Association staff.
Also in Iowa, below are highlights from the June issue of the Iowa Board of Pharmacy newsletter. See the newsletter for additional details and more information.
- The law authorizing pharmacists to administer vaccinations via a practitioner-signed protocol will expire on June 30, 2021. Beginning July 1, 2021, pharmacists may order and administer vaccinations under the Iowa Board of Pharmacy's statewide protocol or according to a patient-specific prescription issued by a practitioner.
- 2021 Regular Session of the Iowa Legislature
- The Board's bill amending the Iowa Controlled Substances Act (CSA) to include nine substances that had been temporarily scheduled via rulemaking and provide conforming text to match federal CSA structure was signed into law.
- The Board's bill (HF 514) eliminating the one-year limitation of a technician trainee registration, revising delegation of functions to pharmacy technicians and pharmacy support personnel, and including other provisions relating to pharmacy practice was also signed into law.
- REMINDER: As of May 12, 2021, Schedule V controlled prescriptions must be reported to the Iowa Prescription Monitoring Program (PMP). Also, newly adopted rulemaking includes nonprescription sales of codeine-containing cough suppressants as reportable transactions.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
The Board of Pharmacy has published guidance for prescribers and dispensers of controlled substances on how to correct records submitted to the Kentucky All-Schedule Prescription Electronic Reporting (KASPER) system.
Also, in Kentucky, NACDS reminds members that effective July 1, 2021, MedImpact will be the single pharmacy benefits manager for the managed care program. For more information including provider notices and updates go to the Kentucky Medicaid Pharmacy Program page.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Maine
As the Maine Legislature moves toward adjournment two key pieces of legislation have been signed into law. First, Governor Janet Mills (D) signed into law Legislative Document (LD) 603 — critical legislation that will help enhance patients’ access to convenient and affordable pharmacy-based care by recognizing pharmacists as providers of healthcare services in the state of Maine. The Governor also signed into law Legislative Document (LD) 8, the prescription drug disposal proposal that would expand the collection of unwanted prescription drugs for proper disposal and will be fully funded by the drug manufacturers.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
The Department of Health published the Final Rule increasing the Medicaid Pharmacy Dispensing Fee from $11.49 to $11.67. The increase is retroactive to Feb. 1, 2021.
Also in Maryland, HB14 has taken effect without the Governor's signature. Pharmacists may now utilize the manufacturer's expiration date on prescription drugs issued in the original manufacturer's packaging.
Also in Maryland, On June 15 the Department of Health issued an Amended Directive and Order Regarding Vaccination Matters that supersedes and replaces previous orders. Notably, it recognizes the ability of trained personnel to administer vaccines at vaccination sites under supervision.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Department of Health (MDH) has given notice of intent to adopt guidance on the implementation of the Prescription Drug Price Transparency Act of 2020. MDH will accept written, electronic comments until 4:30 PM CT on June 24. Questions may be sent to health.Rx@state.mn.us. For additional information or to sign up for email updates go to MDH’s Prescription Drug Transparency Webpage.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.