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.
Indiana
The Office of the Secretary of Family and Social Services issued a notice of a proposal to reimburse COVID-19 vaccine administration and monoclonal antibody treatment at the Medicare rate, effective July 1, 2021. Comments are due June 25, 2021. Contact Sara Albertson; FSSA, Office of Medicaid Policy and Planning; 317-233-4455; spacomment@fssa.in.gov
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Board of Pharmacy released a response to the Governor’s new Proclamation of Disaster Emergency issued on May 27, extending much of the pharmacy practice regulatory relief. The suspension of regulatory provisions identified in the Proclamation is effective through June 26, 2021, unless otherwise extended or terminated by Gov. Kim Reynolds (R). Please note the suspension of Iowa Code § 155A.32 to allow a pharmacist to engage in therapeutic drug product substitution, according to Board guidance, should not be expected to be further extended.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Maryland
Effective May 30, due to the enactment of HB 135 pharmacists may administer certain injectable maintenance medications. The bill was sponsored by Del. Karen Lewis Young (D) and specifically includes drugs for psychiatric disorders, substance abuse, contraception, and vitamins. NACDS assisted in the efforts of both the Maryland Pharmacists Association and the Maryland Association of Chain Drug Stores in supporting this measure.
Also in Maryland, Gov. Hogan (R) signed SB 537, a bill that requires pharmacists to inform patients of lower-cost alternative drugs if the information is readily available. It will also permit pharmacists to interchange a less expensive brand-name drug that is therapeutically equivalent to the prescribed drug under certain conditions. The bill will be effective October 1, 2021; however, the Board of Pharmacy is required to promulgate regulations for certain provisions of the legislation.
Also in Maryland, the Board of Pharmacy recently shared that they will be reaching out to about 1200 pharmacists in Maryland who need to register with the Prescription Drug Monitoring Program (PDMP). To register, click here. For further information about registering see the Board’s FAQ.
Also in Maryland, the Department of Health has renewed its standing order allowing the dispensing of naloxone without a prescription. The order will remain in effect until June 1, 2023.
Lastly in Maryland, the Maryland Association of Chain Drug Stores (MACDS) is seeking a pharmacist to serve on the Maryland Pharmacy Coalition Scope of Practice and Reimbursement Task Force. You can review the minutes from their most recent monthly meeting here. Please contact Jill McCormack if you are interested in participating.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Gov. Michael Parson (R) may soon call a special session to address one critical piece of the budget, the Federal Reimbursement Allowance (FRA) or provider tax extension. FRA is a key funding mechanism for the Missouri Medicaid program for pharmacy, hospitals, nursing homes, and ambulance districts. Failure to extend these provider taxes will create a multi-billion dollar shortfall in Medicaid funding when the new federal fiscal year begins on October 1, 2021.
Also in Missouri: before adjournment, the legislature finally passed SB 63, a Prescription Drug Monitoring Program (PDMP) bill, making it the 50th state to adopt a statewide program.
Lastly in Missouri, unfortunately, although a PBM reform bill HB 834 by Rep. Dale Wright (R) did pass the House 126-8, it failed to advance in the Senate.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nevada
Before the adjournment of the biennial session on May 31, legislators passed four bills NACDS and the Retail Association of Nevada promoted that expand pharmacists’ scope of practice and mandate public and private payor reimbursement for services rendered.
- SB 425 by Sen. James Settelmeyer (R) authorizes pharmacists to provide PEP/PrEP and recognizes pharmacists as health care providers mandating payment by both public & private payors.
- SB 190 by Sen. Nicole Cannizzaro (D) allows pharmacists to furnish self-administered hormonal contraceptives under BOP protocol,
- SB 229 by Sen. Julia Ratti (D) expands collaborative practice agreements and recognizes pharmacists as health care providers so they can be paid.
- AB 178 by Assemblywoman Melissa Hardy (R) authorizes payment for a fill or refill of a 30-day supply of a prescription during a declared disaster or state of emergency.
Also in Nevada, unfortunately, AB 177 by the Assistant Majority Leader Assemblywoman Teresa Benitez-Thompson (D) that NACDS opposed was sent to the Governor. As originally filed, the bill required a pharmacy to provide a second prescription label on the vial in any language the patient requests. As a result of efforts by the Retail Association of Nevada (RAN), the bill was amended to require only a second label be attached to the vial translating the directions for use. RAN also negotiated liability protections to be added for both pharmacies and pharmacists who follow the rules.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Board of Pharmacy amended regulations under 16.19.26 NMAC to establish standards for pharmacist prescribing of protocol formulary dangerous drugs and address prescribing of dangerous drugs in conjunction with point-of-care testing. The rule also revises the definition of “hormonal contraception drug therapy” to include formulary products delineated in the written contraception protocol, including emergency contraception. In addition, the rule clarifies requirements for reporting vaccine administration. The rule is effective May 31, 2021.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Ohio
NACDS reminds members that HB 6 was effective on May 14. The law, sponsored by Rep. Bill Roemer (R), authorized pharmacists to administer the COVID-19 vaccine to individuals over the age of seven. It also authorized pharmacists to order and administer tests for COVID-19 and COVID-19 antibodies. Pharmacy interns and certified pharmacy technicians may also order and administer tests under so under direct supervision. Additionally, it allows the Board of Pharmacy to register pharmacy technician trainee applicants over the age of 17 without a high-school diploma if the individual is enrolled in a career-technical school program. The board may also authorize applicants who are registered in another state or have satisfactory work experience or certification in a state without a registration process in place.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
HB 2648, related to pseudoephedrine (PSE), was passed by the Senate Committee on Health Care and transmitted to the Senate floor for consideration. The bill would remove the existing prescription only requirement and require an electronic system to track all over-the-counter sales of PSE in the state.
Also in Oregon, the agenda for the next Board of Pharmacy meeting being held June 9-10, 2021, has been posted.
Laslty in Oregon, the Health Authority adopted temporary regulations under OAR 333-003-5000 to prohibit health care providers and vaccine sites from requiring parental consent for coronavirus (COVID-19) vaccination for minors age 15 to 17 who are exercising their right to consent under state law. The rule also establishes civil penalties of up to $500 per day per violation. In addition, the temporary regulations (OAR 333-047-2000) require persons or entities receiving state-supplied COVID-19 vaccines to comply with the OHA’s COVID-19 Vaccine Administration Site and Provider Guidance. The rules are effective May 27, 2021, and expire November 22, 2021.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
SB 982 was signed by Governor Bill Lee (R) on May 25, 2021, and removes pharmacies from oversight of the Tennessee Medical Laboratory Board and makes the state list of CLIA waived tests the same as the federal CLIA waived tests, easing previous restrictions on Tennessee pharmacies holding an active CLIA waiver.
Also in Tennessee, HB 1398 which establishes PBM standards around 340B discrimination, prohibits patient steering, prevents spread pricing and below-cost reimbursement as well as a provision, which goes into effect January 1, 2022, that requires a PBM or other health care payer, upon request of an enrollee, health care provider, or authorized third party, to furnish the cost, benefit, and coverage data of a health care plan. The bill was signed by Governor Bill Lee (R) on May 26, 2021, and (unless otherwise indicated) will take effect on July 1, 2021.
Lastly in Tennessee, the Department of Health published a proposed rule to amend, adopt, and repeal regulations under RRT 1140-11 and 1145-01 to require dispensing health care practitioners or their agents to submit specified data to the Controlled Substance Database. The rule also would not require the reporting of Schedule V controlled substances that can be dispensed without a prescription. A hearing is scheduled for August 4, 2021, in Nashville.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Prior to the legislature adjourning its biennial regular session on May 31, the legislature approved two bills NACDS supported relating to the contractual relationship between a pharmacist or pharmacy and a Health Benefit Plan Issuer or Pharmacy Benefit Manager.
- HB 1763 by Rep. Tom Oliverson (R) regulates the contractual relationships between a pharmacist or pharmacy and a health plan or PBM. NACDS supported the following provisions of H.B. 1763:
- Provisions that helped ensure that Texas pharmacies may be fairly and properly reimbursed for the prescription medications they provide and associated pharmacy services such as preventive treatments, immunizations, and helping patients access and take their medications accurately and safely;
- Provisions that required equal access to all network pharmacies and should help all Texans continue to receive care from the pharmacy of their choice;
- Provisions that required the terms of pharmacy contracts be clearly defined, especially concerning drug pricing and prohibiting the claw back of pharmacy reimbursement after a claim has been adjudicated at the point of sale.
NACDS submitted a letter urging Gov. Greg Abbott (R)to sign the bill, which he did on May 26 with an effective date of September 1, 2021.
- HB 1919 by Rep. Cody Harris (R) will help maintain patients’ right to choose a pharmacy provider by prohibiting health benefit plans and pharmacy benefit managers from “steering” or otherwise directing patients to use any particular in-network pharmacy provider over another. This bill helps ensure that patients are not penalized for choosing the pharmacy provider that best suits their individual needs. NACDS submitted a letter urging Gov. Abbott to sign the bill into law before the June 20th
Also in Texas, unfortunately, three bills NACDS supported died.
- HB 678 by Rep. Phil Cortez (D) would have removed the existing administrative barriers requiring a prescription for influenza vaccines given to patients younger than 7 years of age and for any other vaccine given to patients younger than 14 years of age. This legislation proposed to align Texas requirements for vaccines given to younger people with the U.S. Department of Health and Human Services’ declaration under the Public Readiness and Emergency Preparedness Act that “authorizes state-licensed pharmacists to order and administer vaccines to individuals ages three through 18 years.” It passed the House by a vote of 139-7 but died in the Senate; and
- HB 2049 by Rep. Donna Howard (D) would have allowed pharmacists to furnish medications according to the result of a positive Clinical Laboratory Improvement Amendments (CLIA)-waived test for acute conditions such as flu and strep throat passed the House Public Health Committee but failed to be set on the House Calendar.
- HB 2346 by Stephanie Klick clarifying the law that stops the Health and Human Service Commission’s Vendor Drug Program (Medicaid) from proceeding with recent guidance to pharmacies to include discount card and membership program pricing in their calculations for Medicaid reimbursement rates died in the House Human Services Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The telemedicine rules workshop scheduled for June 4 was canceled. For more information about when it will be rescheduled, contact Amelia Boyd, Program Manager, at amelia.boyd@wmc.wa.gov.
Also in Washington, the Health Care Authority (HCA) issued a primary care stakeholder survey aimed at gathering provider and other stakeholder input on proposed provider accountabilities under the WA Multi-payer Primary Care Transformation Model. Feedback from this survey will be combined with payer input to build out an overall framework of accountabilities for both providers and payers under the Model.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
AB 1430, legislation requiring pharmacies to dispense Schedule II prescription drugs in lockable vials, was held on the Assembly Appropriations Suspense File and will not advance.
Also in California, the following bills failed the policy/legislative deadline and have become two-year bills. They may not be acted upon until January 2022.
- AB 458, legislation creating the Affordable Prescription Drug Importation Program in the California Health and Human Services Agency (CHHSA), under which the state would be a licensed wholesaler that imports prescription drugs for the exclusive purpose of dispensing those drugs to program participants upon federal approval for the importation program.
- AB 933, legislation requiring an enrollee’s or insured’s defined cost-sharing for each prescription drug to be calculated at the point-of-sale based on a price that is reduced by an amount equal to 90% of all rebates received, or to be received, in connection with the dispensing or administration of the drug. It would also prohibit a health care service plan, health insurer, or a plan’s or insurer’s agents from publishing or otherwise revealing information regarding the actual amount of rebates the health care service plan or health insurer receives on a product-specific, manufacturer-specific, or pharmacy-specific basis.
Also in California, the Office of Administrative Law has approved the following proposals. The amended and new regulations are effective July 1, 2021.
- To amend sections 1711 and 1713, and add section 1715.1, in Article 2 of Division 17 of Title 16 of the California Code of Regulations, regarding Automated Drug Delivery Systems.
- To amend section 1707 in Article 2 of Division 17 of Title 16 of the California Code of Regulations, regarding Waiver Requirements for Off-site Storage of Records.
Lastly in California, the Department of Health Care Services posted the User Administration Console (UAC) Registration Troubleshooting bulletin on the Medi-Cal Rx web portal. Additionally, DHSC issued the Medi-Cal Rx User Administration Console (UAC) Application Role bulletin to prepare pharmacies and prescribers for the upcoming Medi-Cal Rx transition by providing information on the currently available applications and their functionalities within the Medi-Cal Rx Secured Provider Portal.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
The Florida Board of Pharmacy issued a proposed rule that would amend regulations under FAC 64B16-31 to update references to the incorporated application forms for pharmacy interns, consultant pharmacists, nuclear pharmacists, and pharmacy technicians. Comments and hearing requests are due June 14, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Georgia
The Georgia Board of Pharmacy issued a final rule to amend regulations under GAC 480-10 to require a Class A balance with weights or electronic balance only if compounding on-site using components that must be weighed. The rule became effective May 10.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The next meeting of the Iowa Board of Pharmacy’s IMP3 Committee meeting is scheduled for June 2, 2021. The information and agenda have been posted.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oklahoma
In The Oklahoma Register Vol. 38 No. 17, the Oklahoma Health Care Authority published an emergency rule amending regulations under OAC 317:30-5 to revise provisions regarding diabetes self-management education and support providers to update requirements for Medicaid payment of providers and requirements that such providers be certified. The rule also allows registered dietitians, registered nurses, and pharmacists to render services and be reimbursed when meeting specific licensure, training, and experience requirements. The rule became effective April 14 and expires September 14, 2022.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Texas
On May 26, Gov. Abbott signed HB1763 into law which becomes effective September 1, 2021. NACDS applauds Gov. Abbott, Sen. Lois Kolkhorst (R), Rep. Tom Oliverson (R), Sen. Bryan Hughes (R), and Rep. Eddie Lucio III (D) for passing this important legislation and look forward to continued collaboration on these efforts that maintain patient access and creates long-term viable reimbursement models in the commercial market. HB1763 is crucial for the continued viability of retail community pharmacies in Texas by creating PBM reform that prohibits harmful claw backs, requires that all pharmacies be fairly and properly reimbursed, and provides patients with equal access to all network pharmacies by allowing patients to receive care from the pharmacy of their choice. In a letter of support, NACDS urged Gov. Abbott to sign HB1763 to maintain patient access and help ensure that local Texas pharmacies are properly reimbursed for the prescription medications they provide and associated pharmacy services.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Board of Pharmacy has posted the agenda for the June 4 meeting. The BOP will be reviewing legislation passed by the General Assembly in the 2021 session including HB 2079 (initiation of treatment, dispensing of supplies and devices; HIV treatment; test & treat for CLIA-waived tests including flu and strep; tobacco cessation prescribing). A stakeholders’ workgroup will be convened to make recommendations on CLIA test and treat to the Joint Commission on Health Care due November 1, 2021. Additionally, there will be another workgroup tasked with making recommendations on expansion pharmacy technicians’ duties as a result of the passage of HB 1304 of 2020 with a report also due November. 1. Further detail is in the agenda packet. NACDS and VACDS expect to participate in both stakeholder workgroups.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
The Board of Pharmacy published an emergency rule to adopt regulations under AAC 680-X-2 to establish standards for off-site COVID vaccine order entry processing. The rule is effective April 7 and expires October 2, 2021. Please contact Wendy Passmore; Board of Pharmacy; 205-981-4764; wpassmore@albop.com for more information.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Department of Health and Social Services, Division of Health Care Services issued a Notice of Public Scoping: Medicaid Pharmacy Services, Coverage & Reimbursement announcing its review of coverage and reimbursement related to Medicaid Pharmacy Professional Dispensing Fees, pharmacist rendered professional services, covered outpatient drugs, and cost-sharing. The public scoping session will take place on May 24, 2021, via teleconference/WebEx, and written comments will be accepted until June 4, 2021.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
NACDS and the California Retailers Association submitted a joint letter to the Assembly Appropriations Committee in opposition to AB 1341, which will prohibit the sale of over-the-counter dietary supplements to individuals under 18 years of age without a prescription and will also require retailers and pharmacies to store these products behind the counter. We expressed concern this will create substantial workflow issues and take time away from patient care. Additionally, this action will restrict access to these safe FDA-regulated products forcing many consumers to turn to less-regulated, misbranded, and dangerous supplements sold online.
Also in California, on May 14, Gov. Gavin Newsom (D) released the 2021-22 Governor’s May Revision related to the state’s budget process. Included in the Health and Human Services section of the May Revision is funding to implement an MTM program for specialty pharmacy services in the Medi-Cal program, effective July 1, 2021. Additionally, the May Revision is absent of a clear plan of implementation for the transition of the Medi-Cal Rx prescription drug benefit from managed care to fee-for-service. The Department of Health Care Services continues to work with the contracted vendor to finalize the conflict avoidance plan. In light of this uncertainty, the May Revision assumes that the transition will take place on January 1, 2022, for budgeting purposes only. The state’s contracted vendor will continue meeting with pharmacy providers to working towards future implementation of the transition.
Also in California, the Assembly Budget Subcommittee on Health & Human Services has voted to approve the Governor’s proposal to cover continuous glucose monitors for adult Medi-Cal beneficiaries. The proposal is awaiting action in the Senate. If approved by both chambers, the proposal would be included in the state budget for approval by the Governor.
Also in California, the State Board of Pharmacy published its agenda for the May 27, 2021, teleconference public board meeting.
Also in California, the Board announced the following related to pharmacy law waivers issued during the coronavirus pandemic.
- Pharmacy Law Waivers – Notice of Extension
- Pharmacists Initiating and Administering Vaccines (related to reporting requirements)- Expiration: August 27, 2021, or until 30 days after the emergency declaration is lifted, whichever is sooner
- Remote Processing – Expiration: June 30, 2021
- Pharmacy Law Waivers – Set to Expire – Effective through May 31, 2021
Also in California, the Department of Health Care Services posted a step-by-step user guide for the Coronavirus (COVID-19) Uninsured Group Web Application Web Portal on the Medi-Cal Providers website. The Families First Coronavirus Response Act, Section 6004, authorized State Medicaid programs to provide access to COVID-19 diagnostic testing and testing-related services at no cost to the individual.
Also in California. The Medi-Cal Update – Part 1 – Program Eligibility Bulletin – May 2021 highlights information related to ICD-10 codes for individuals in aid code V2 (COVID-19 Uninsured Group) and updates to the ineligible provider list among other program elements and updates. Also, the Medi-Cal Update – Durable Medical Equipment and Medical Supplies – May 2021 – Bulletin 548 includes information about the new NDC for Moderna COVID-19 vaccine, updates to the List of Enteral Nutrition Products and various coding changes and provider manual updates.
Lastly in California, Attorney General Rob Bonta issued an alert advising the public that they should not be charged for their COVID-19 vaccination and warning vaccination providers not to ask individuals to pay to receive their vaccine.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.