North Carolina
The Department of Health and Human Services (NCDHHS) is encouraging everyone 6-months and older to get their seasonal flu shot and COVID-19 vaccine. Both vaccines have been updated for the new flu and COVID-19 virus strains that will continue to spread this fall and winter.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
North Dakota
The Health and Human Services (HHS) Immunization Unit and key partners are conducting a Community Survey to inform development of a new Immunization Strategic Plan for the state. As a member of our community, your input and opinions about vaccines and vaccination uptake and access in North Dakota is highly valued. Your response to this survey will help state and local health groups work to ensure all North Dakotans can be healthier and happier by staying current with wellness immunizations. Please use the link or QR code below to complete the anonymous survey, which will take approximately 10–15 minutes. No personally identifying information will be collected.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Oregon
The Prescription Drug Affordability Board (PDAB) posted the agenda and meeting materials for its October 2 meeting. Please note the “Medicare MFP modeling presentation and SB 192 upper payment limit discussion” by PDAB staff and Myers and Stauffer on the agenda. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Vermont
On September 25, the Board of Pharmacy held its regular meeting. Of interest, one posted agenda item was new officer elections.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Virginia
The Department of Medical Assistance Services (DMAS) is currently conducting a pharmacy cost of dispensing study. Surveys were delivered to pharmacies on September 12 and are due back to Myers & Stauffer on October 17. The statute requires that the Medicaid Fee-For-Service (FFS) Professional Dispensing Fee be determined by a study completed “at least every five years”. DMAS’ slide deck has more detail. The current FFS Professional Dispensing Fee is $10.65.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Alabama
Effective October 1, 2024, Medicaid will:
- Continue to monitor the stimulant shortage affecting ADHD medications.
- Add the Asthma and Allergy Monoclonal Antibodies class to the PDL.
- Require PA for generic bepotastine besilate ophthalmic solution, and generic budesonide/formoterol fumarate inhalation, including Breyna. Brand Bepreve and brand Symbicort will remain preferred and will be billed with a Dispense as Written (DAW) Code of 9.
- Update the PDL to reflect the quarterly updates listed at the link.
Also in Alabama, this ALERT was published on July 2, 2024; however, Medicaid sent the information to providers again as a reminder of upcoming changes starting on October 1, 2024, related to COVID-19 unwinding.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
Licensing applications that were unable to be renewed prior to June 30, 2024, were given a 90-day extension if the application was received and the fee was paid. If the extended applications are not completed by September 30, 2024, the license will move into lapsed status on October 1, 2024. Pharmacists need to complete their Alaska Law Questionnaire and upload it into their My License portal. Pharmacies and Facilities must provide the Board of Pharmacy with their Alaska corporate entity number.
Also, in Alaska, effective September 28, pharmacy technicians with national certification can perform expanded duties under the direct supervision of a pharmacist (12 AAC 52.235). PHARMACY TECHNICIAN WITH NATIONAL CERTIFICATION). Specifically, certified technicians can perform a final check of and distribute a non-controlled substance prescription if the pharmacy uses software that displays the image or graphical description of the correct drug being verified.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Board of Pharmacy announced effective September 3, online renewals were available in your online profile by clicking the “Renewal” button located near the top of the page. Once you have successfully renewed, your updated license / permit will be available in your online profile. Renewal applications submitted after November 7, 2024, will be assessed as a late renewal penalty.
For licensee renewals, please ensure you have completed all continuing education (“CE”) requirements before submitting your renewal application. You may review the 2024 CE requirements.
When submitting your renewal application, please use a standard desktop or laptop computer running a current version of Google Chrome; the online profile may not be compatible with mobile devices.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
The Insurance Department (“AID”) will host a Public Hearing on October 22, on proposed RULE 128 FAIR AND REASONABLE PHARMACY REIMBURSEMENTS that NACDS support. AID provide a summary of the rule.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Insurance Commissioner Ricardo Lara issued the following statement, urging Governor Newsom’s signature on SB 966, which reflects a shared commitment to making healthcare more affordable, accessible, and transparent for all Californians:
“Senate Bill 966 is a game-changer for California consumers. For too long, Pharmacy Benefit Managers (PBMs) have operated in the shadows, impacting drug prices and patient access with little oversight. SB 966 will bring much-needed transparency and accountability to this critical part of our healthcare system. I strongly urge Governor Newsom to sign this bill, which will help ensure that consumers—not corporate intermediaries—benefit from the savings PBMs negotiate with drug manufacturers.”
Also in California, the Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal:
- State of Emergency Override Activation: Submission Clarification Code 13 (September 18)
- Medi-Cal Rx Weekly Wrap-up for September 6-12
- State of Emergency Override Actions: Submission Clarification Code 13 (September 12)
- Mass Adjustment for Professional Dispensing Fee Amount Decrease for Impacted Claims with a Date of Service July 1, 2022, through October 3, 2022
- Mass Adjustment for Impacted Paxlovid Renal Dose Claims with a Date of Service April 1, 2022, through January 17, 2024
- Mass Adjustment for COVID-19 Vaccine Incentive Fee for Impacted Claims with a Date of Service April 1, 2022, through September 31, 2022
- Medi-Cal Rx Weekly Wrap-up for August 30-September 5
Also in California, the Department of Health Care Services posted the following:
- September 2024 Pharmacy Medi-Cal Update Bulletin
- September 2024 Durable Medical Equipment and Medical Services Medi-Cal Update Bulletin
Also in California, the Board of Pharmacy (Board) announced starting January 1, 2025, licenses that are eligible for renewal will be processed only online. Those who are eligible include:
- Pharmacist
- Advanced Practice Pharmacist
- Pharmacy Technician
- Designated Representative – Wholesaler
- Designated Representative – Veterinary Food-Animal Drug Retailer
- Designated Representative – 3PL
- Designated Representative – Reverse Distributor
Note: In most cases, the license expires at the end of the month of the licensee’s registered birthday for pharmacists, advanced practice pharmacists and pharmacy technicians. For designated representatives, the license expires on the first of the month.
The Board will no longer mail out a paper renewal application for the above licensees. In its place, a postcard reminder will be sent approximately six weeks prior to the license expiration date and the licensee will renew by going to www.pharmacy.ca.gov. The postcard is only a reminder, if the licensee does not receive a postcard, they are still required to submit their payment on-time to avoid a delinquency fee and cancellation of the license.
For Pharmacists and Advanced Practice Pharmacists, if your license expired more than two years ago, you are not eligible to renew your license online. Contact the Board at RenewalStatus@dca.ca.gov for assistance.
Renewal payment transactions must be completed prior to 5:00 pm Pacific Time on the date your license expires to avoid the delinquency fee.
Online payments made after 5:00 pm Pacific Time are not credited on the day of the transaction. The Board recommends you print your payment confirmation at the end of this transaction for your records. Once the online payment is submitted, please allow two business days for processing.
Reminder, confirm address is correct. You must notify the board of any change in your address within 30 days. Change of address may take between 7-10 business days to update the system. If the correct address is not in the system at the time of renewal, the process may be delayed. Address changes can be made on-line or in writing to the board.
When renewing online, the licensee must confirm that their address is correct before submitting the payment.
Finally in California, the Board of Pharmacy stated licensees continue to report being victimized by scam callers claiming to represent the Board of Pharmacy (Board).
In a recent attempt, the caller claimed to be a Board inspector who told the pharmacist they were charged with drug trafficking and money laundering in Texas. They told the licensee they needed to go to Texas to face charges. The caller insisted the licensee stop practicing immediately.
Two other individuals who claimed to be FBI agents were also on the phone call. And the licensee received an official looking letter of their suspension. Fortunately, this licensee contacted the Board and confirmed that they were in good standing and not part of any investigation.
Techniques used by fake callers include:
- A caller uses a caller ID that says “CA State Board of Pharmacy” with the Board’s phone number, (916) 518-3100.
- The caller claims a licensee is under investigation by the Board, the California Department of Consumer Affairs (DCA), the DEA, the FBI, or another government agency. In some cases, the caller also warns of discipline unless the licensee pays a “fine.”
- A caller warns a licensee not to report the call to anyone “or else you will jeopardize the investigation.”
- A caller requests a licensee’s cell phone number.
- A caller gives a fake call-back number.
In many cases, callers are attempting to extort money or elicit sensitive information – e.g., license numbers, DEA registration numbers, etc. – from licensees.
What can you do to protect yourself and your pharmacy?
Licensee security is important to the Board of Pharmacy. Be aware of these tips from the Board and DCA:
- If you have any doubts or questions about someone claiming – by phone or in person – to represent the California State Board of Pharmacy, call the Board at (916) 518-3100.
- To check the identity of a caller who claims to be conducting a DCA investigation, call DCA directly at (800) 952-5210.
- If a scam caller claims to represent the DEA or the FBI, report the call to the DEA’s Extortion Scam reporting program or the FBI’s Internet Crime Complaint Center.
- If a scam caller’s phone number appears to be a Board of Pharmacy or DCA telephone number, report the scam using the Federal Communications Commission’s consumer complaint form.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Colorado
A Pharmacy Workplace Conditions and Well-being Summit, jointly sponsored by the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences and Regis University School of Pharmacy, will be held on September 30th.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
MedImpact issued a bulletin outlining the following COVID-related coverage and policy changes, effective Oct.1 2024, pursuant to the expiration of the American Rescue Plan (ARP):
- COVID-19 OTC tests will be limited to four per member per rolling 90 days. Patients requiring more tests will be required to submit a prior authorization request for review. Kentucky’s Statewide Physician Protocol for Point of Care COVID-19 Testing will be updated to reflect the changes to allowed quantity limits.
- The COVID-19 vaccine administration fee will remain the same. Pharmacies administering COVID-19 vaccines will continue to be reimbursed at $40.
- Pharmacies may continue to bill CPT code 99401 for standalone vaccine counseling.
- COVID-19 treatments classified as EUA (Emergency Use Authorization) may be subject to additional prior authorization review for coverage.
Also in Kentucky, Medicaid issued a Statewide Physician Protocol for Point of Care COVID-19 Testing. The protocol, meant for pharmacies who do not have a medical director, applies only to testing for Medicaid patients.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health (LDH) issued a memo clarifying they are continuing to reimburse pharmacies for at-home OTC COVID-19 diagnostic tests to Medicaid patients through December 31, 2024.
Also in Louisiana, on September 9, 2024, Governor Jeff Landry declared a state of emergency for Tropical Storm Francine. LDH issued a memo detailing the procedures for emergency prescriptions claims for Medicaid beneficiaries
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The Board of Pharmacy held a pharmacy rule-making subcommittee meeting on September 16, 2024, regarding updating the board rules. The subcommittee goals are
- Protect the public
- Update/Modernize current rules
- Streamline to eliminate repetition, separate rules from statutes
- Create an easy-to-use reference for all stakeholders
- Ensure our rules align with current Federal law and allow for modern pharmacy practice
They reviewed chapters four and five of rules, which cover registration and continuing education. The next meeting will be October 21, 2024.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Michigan
Sen. Santana has introduced SB 993, a “trailer” bill that require insurers to reimburse pharmacies for the vaccination and test and treat services authorized under P.A. 97 of 2023. The bill was referred to the Senate Health Policy Committee and could see action as early as this fall.
Also in Michigan, the Department of Health, and Human Services (MDHHS) has issued a final bulletin ending three temporary COVID-19 Medicaid Pharmacy provisions due to the COVID-19 PHE.
- HASA 22-02 – Authorization of U.S. Food & Drug Administration (FDA) Emergency Use Authorization (EUA) pharmacist prescriptive authority of oral antivirals for the treatment of COVID-19;
- MMP 22-29 – Coverage of FDA EUA COVID-19 monoclonal antibody injections by pharmacy providers; and
- L 22-04 – Stand-alone vaccine counseling services billed as a Medication Therapy Management service.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
DHS has published a provider update with details about the November 4th transition to the new claims processing system. On October 16 they will host what they anticipate will be the last provider virtual meeting prior to implementation and have posted the call in information. Lastly, they have also released the payer specification document for claims processing and billing.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New Hampshire
The New Hampshire Board of Pharmacy will be holding a hearing on September 25, 2025, at 9:30 am to review the repeal of three rules. The three rules being repealed are (1) in regard to unused prescription drugs, (2) the New Hampshire Controlled Drug Prescription Health and Safety Program, and (3) Continuous Quality Improvement. In lieu of attending, written comments can be submitted to OPLC-Rules@oplc.nh.gov.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
New York
On September 5, Governor Hochul signed into law the Retail Workers Safety Act, which requires employers to implement policies and training programs to prevent workplace violence. It requires a retail store with 500 or more employees to install panic buttons in all New York locations. The Department of Labor would be required to create a model workplace violence prevention training program, policy, and guidance document to be utilized by employers. The law is effective March 4, 2025, however the section requiring panic buttons would take effect January 1, 2027.
On September 13, 2024, the New York Pharmacy Conference held its regular meeting. The meeting included updates from Donate Life New York State, the Comprehensive Contraceptive Coverage Act, and Expansion of Collaborative Drug Therapy Management to offsite practices, and a legislative update from Assemblyman John McDonald. The next meeting of the conference will be held on Friday December 13, 2024, at 10 AM.
On September 18, 2024, the New York Department of Health held their monthly pharmacy industry call regarding NYRx, the Medicaid Fee-For-Service Program. This month’s call included updates on Blood Glucose Test Strip Coverage Policy and Covid Tests Coverage Policy Update.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Ohio
The Board of Pharmacy published the following final rules:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) moved its next meeting from September 18 to October 2 due to unforeseen scheduling issues and lack of a quorum. The agenda has been updated to reflect this change. Please note the “Medicare MFP modeling presentation and SB 192 upper payment limit discussion” by PDAB staff and Myers and Stauffer on the agenda. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
Effective October 1, 2024, over the Counter (OTC) COVID-19 testing kits will no longer be covered under TennCare’s pharmacy benefit due to the end of the COVID-19 Public Health Emergency. Beginning October 1, 2024, Covid Test Kits will remain a covered benefit under the medical benefit.
Effective September 1, 2024, TennCare began reimbursing pharmacy providers through the OptumRx Pharmacy Point of Sale System (POS) for the administration of newly FDA approved COVID-19 vaccines for the 2024-2025 Formulas. Per FDA guidance, previous versions of COVID-19 vaccines are no longer recommended or authorized for use. CoverKids and CoverRx claims also follow this FDA guidance.
Claims for COVID-19 vaccines are exempt from co-pays and script limits for all TennCare enrollees.
COVID vaccine claims for dual eligible members (Both Medicare and Medicaid eligible) will receive NCPDP Reject 65 “Patient has Medicare Coverage, Bill Medicare.”
Please note for TennCare members, effective October 1, 2024, the Covid-19 vaccine reimbursement will change to include only the cost of the vaccine plus the Professional Dispensing Fee (PDF). The $40 administration fee will be discontinued. Therefore, the Incentive Amount Submitted (NCPDP Field 483-E3) is no longer required for claim submission. If you have a TennCare Medicaid ID, you may contract with the individual Managed Care Organization(s) to bill for ancillary services. Please contact the designated health plan Provider Services for assistance.
Also in Tennessee, prior authorization requirements can be bypassed for certain medications when specific medical conditions exist. The submitted claim should include a Diagnosis Code Qualifier (Field # 492- WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). See a list of the preferred agents and the clinical criteria here, and see the list of Tennessee OptumRx Provider Liaisons here.
Finally in Tennessee, the Tennessee Pharmacists Research and Education Foundation (TPREF) is proud to offer an ACPE-accredited OSHA training webinar that meets all of OSHA’s annual training requirements, with ten sessions offered between September 25 and October 23. Register for one of the sessions!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Texas Pharmaceutical Initiative (TPI) Board is meeting on September 23.
Also in Texas, Speaker Dade Phelan (R) appointed Rick Perry (R), former Governor of Texas and Secretary of Energy under the Trump Administration, as a senior advisor to his leadership team.
Also in Texas, the Department of State Health Services (DSHS) resolved the issue of providers receiving errors when submitting Unsolicited Vaccine Updates (VXU) messages through data exchange for influenza vaccines. The seasonal influenza vaccines for 2024–2025 have been updated in ImmTrac2 as of Aug 30, 2024. Please refer to the Fall Season Respiratory Vaccine Codes | Immunization Information Systems (IIS) | CDC for the correct codes to report for influenza 2024–2025 vaccines to ImmTrac2.
Finally in Texas, the Senate Health and Human Services Committee held a hearing focused on expanding access to healthcare services and NACDS submitted a support letter.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
The Board of Pharmacy will be holding its regularly scheduled meeting on September 25, 2024, at 9:00 am. The meeting will be hybrid and recorded.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Alabama
Mandatory provisions of the Affordable Care Act require the Medicaid Agency (Medicaid) to select and provide oversight for a Medicaid Recovery Audit Contractor (RAC) to perform provider audits. Alivia Analytics, LLC (Alivia) was selected to be Medicaid’s RAC effective October 1, 2024. The RAC program is designed to improve payment accuracy by identifying under and overpayments in Medicaid. The Medicaid RAC program is separate from the Medicare RAC overseen by the Centers for Medicare and Medicaid Services.
Reviews will be conducted by Alivia staff to include a medical director, certified professional coders and experienced clinicians. Audits will be conducted by Alivia using a “top down” approach where data analysis, through data mining, is applied against the universe of paid claims to identify patterns of utilization or billing which look atypical based on Medicaid and/or national standards. Following the high-level claims analysis, Alivia may expand its review by requesting clinical records and/or other documents in accordance with state and federal regulations.
Alivia has been informed of the critical role that all providers play in a successful Medicaid program and requires that auditors be professional, objective and consistent in performing all required audits/reviews.
Providers are reminded that the Alabama Administrative Code, the Provider Manual and their Provider Agreements require compliance with requests for medical records for Medicaid program audits.
Questions regarding the audits should be directed to Jamie Cousins, RAC Program Manager, at (334) 353-8025 or Yulonda Carter, Recipient Review Associate Director, at (334) 242-5161.
Also in Alabama, the State Board of Pharmacy will transition to a new database in October of this year. The new system and the renewal process will look different. The changes will ultimately be positive but require you to create a new account to renew licenses, permits and registrations.
Finally in Alabama, as a reminder, 2024 is a year for pharmacist license renewals and pharmacy permit renewals.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy adopted regulation changes in August related to pharmacy technicians, collaborative practice authorities, sterile pharmaceutical guidelines, manufacturer license requirements, PDMP registration, alternative to probation program and definitions. The regulation changes were reviewed and approved by the Department of Law, signed and filed by the Office of the Lieutenant Governor on August 29, 2024, and are effective on September 28, 2024. The filed version of the regulations will be posted in Register 251, October 2024 of the Alaska Administrative Code.
For more information, contact NACDS’ Mary Staples at 817-442-1155.