Louisiana
The new Medicaid Provider Enrollment Portal designed to meet Centers for Medicare and Medicaid Services (CMS) requirements for screening and enrolling Medicaid providers and must be used by all Medicaid providers, including those who do not participate in fee-for-service will launch in June of 2021. The fiscal intermediary and current provider enrollment vendor, Gainwell Technologies, will send providers an invitation to the mailing address on file when it is time for them to visit the portal and complete the enrollment process. Providers can find additional information and submit questions on the provider enrollment webpage and in the Informational Bulletin 21-5: New Louisiana Provider Enrollment Portal
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nevada
AB177, legislation pharmacies strongly oppose that mandates language translations be on the prescription vial passed the Assembly and is pending action by the Senate Health and Human Services Committee on April 29. The bill requires retail pharmacies to provide the information required to be included on the label of a prescription drug in English and, upon request of a prescribing practitioner, patient, or an authorized representative of a patient, any language prescribed by regulations adopted by the Board.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oklahoma
SB 4, legislation by Sen. Greg McCortney (R) establishing conditions when a pharmacist may substitute an interchangeable biological product for a prescribed biological product was signed into law by Gov. Kevin Stitt (R). The new law will take effect on November 1, 2021.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Texas
On April 26, the House Public Health Committee approved both the immunization bill, CSHB 678 by Rep. Phil Cortez by a vote of 10-0 and the test and treat bill, HB 2049 by Rep. Donna Howard reported favorably without amendments by a vote of 9-0. NACDS members are urged to contact members of the Texas House of Representatives asking them to VOTE YES on both HB 678 and HB 2049. More information can be found here.
Also in Texas, last week, the Texas House passed its proposed two-year, $246 billion state budget after spending hours on controversial issues such as Medicaid expansion and school vouchers.
Lastly in Texas, the Board of Pharmacy is hosting a quarterly virtual meeting on Tuesday, May 11th at 9 AM. The agenda and conference information is available here – Texas State Board of Pharmacy
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The State Pharmacy Association’s (WSPA) bill, HB 1445 by Rep. My Lihn Thai (D), clarifies that the reconstitution and mixing of nonsterile products according to FDA labeling and according to a prescription, often referred to as simple compounding, is not compounding. The bill was signed by Gov. Jay Inslee and will go into effect on July 25, 2021.
Also in Washington, Gov. Jay Inslee (D) signed into law the Second Substitute to HB 1161 which modified the requirements for the manufacturer’s drug take-back programs under the Department of Health.
Also in Washington, Apple Health (Medicaid), administered by the Health Care Authority will implement changes to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program. on June 1, 2021. 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, HB 1127 by Rep. Vandana Slatter establishes privacy and security standards for COVID-19 health data passed both houses and was sent to Gov. Jay Inslee (D) to sign into law.
Also in Washington, the Health Care Authority (HCA) sent a Provider Alert informing providers about updates to the COVID-19 vaccine clinical policy regarding the roster billing for COVID-19 vaccine administration. When billing for vaccines for fee-for-service clients, there are three options:
- Bill each individual claim.
- Use batch 837.
- Template billing.
HCA is no longer requests that you bill the vaccine with the vaccine administration code. If you do submit a claim with both codes, HCA will not pay for the vaccine but will pay for the administration of the COVID-19 vaccine. These policies apply to both fee-for-service (FFS) providers and HCA-contracted managed care organizations (MCOs). For more information go to Apple Health (Medicaid) COVID-19 vaccine clinical policy under Reimbursement information and billing guidance.
Lastly in Washington, the Office of the Insurance Commissioner extended two Emergency Orders until May 16, 2021:
- Notice requires health insurers to waive copays and deductibles for coronavirus testing. It also requires insurers to allow a one-time early refill for prescription drugs; to suspend any prior authorization requirement for treatment or testing of Covid-19, and to allow 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.
- Notice concerning insurance coverage for coronavirus diagnostic testing, prohibiting all health carriers from balance billing for Covid-19 diagnostic testing processed by out-of-network laboratories, when determined to be medically necessary. It also requests that insurers notify the agency if out-of-network laboratories submit claims but have not published a cash price or fail to accept such a price.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
On April 9, Gov. Doug Ducey (R) signed into law SB 1356 (Chapter 217, Laws 2021) prohibiting PBMs, from directly or indirectly, holding a pharmacist or pharmacy responsible for a fee related to the claims adjudication process, including adjudicating a pharmacy benefit claim, processing or transmitting a pharmacy benefit claim, developing or managing a claims processing or adjudication network or participating in a claims processing or adjudication network. Pharmacies may file a complaint of a violation, and a PBM that commits a violation is subject to penalties.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
NACDS and the Arkansas Grocers and Retail Merchants Association submitted a joint letter to the House Public Health, Welfare and Labor Committee urging the committee members to strongly oppose HB 1945 by Rep. Wooten. HB 1945, filed on April 19th would establish discriminatory restrictions on pharmacy ownership and prohibit chain pharmacies from operating pharmacy locations throughout Arkansas. The bill was heard in committee on April 22 and was pulled down and referred to further consideration after the session during the interim study. The legislature is scheduled to adjourn by April 30, 2021.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
On April 20, the Department of Consumer Affairs issued an order waiving the staffing ratio of pharmacist to pharmacy technicians related to the administration of COVID-19 vaccinations. The following language is included in the order: Accordingly, for pharmacists engaged exclusively in initiating and administering COVID-19 vaccines, and pharmacy technicians engaged exclusively in administering COVID-19 vaccines under the direct supervision and control of such pharmacists, the Director waives Business and Professions Code section 4115, subdivision (f)(1) to the extent it limits pharmacies with only one pharmacist to having no more than one pharmacy technician working, subject to the condition that such pharmacies may have no more than two pharmacy technicians working.
Also in California, the Medi-Cal Update Bulletin 989 – April 2019 includes the following items of interest.
- REMINDER: On April 1, the online attestation period opened for fee-for-service Medi-Cal pharmacy providers seeking the higher of two professional dispensing fees as part of the reimbursement for covered outpatient drugs. The attestation period for the 2020 calendar year is open until 11:59 pm April 30, 2021, and no attestations will be accepted after that time.
- Effective for dates of service on or after March 1, 2021,pen needles quantity limits without authorization have been updated to allow 100 pen needles per claim with no more than three (3) claims in 90 days. Pen needles are billed on a pharmacy claim using the contracted product’s National Drug Code (NDC).
Also in California, the Medi-Cal Update – Part 1 – Program and Eligibility Bulletin – April 2021 highlights information related to drug code limitations and Medi-Cal suspended and ineligible provider list among other program elements and eligibility requirements and updates.
Also in California, Medi-Cal announced a System Update beginning at midnight on April 25, 2021, continuing through 6:00 a.m. Point of Service (POS) network Leased line Eligibility and Share of Cost (SOC) transactions may not be available during this time.
Lastly in California, additional agendas have been posted for the following Board of Pharmacy teleconferenced meetings:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
District of Columbia
As a result of NACDS’ efforts with other partner organizations, the DC Department of Health has published a revised concurrent and emergency rule governing COVID-19 testing by pharmacies. The revised rule which was effective April 1, now allows: off-site testing, pharmacy technicians to perform testing, is consistent with the CDC’s guidelines for Personal Protective Equipment (PPE), and no longer requires testing by appointment only.
Also in the District of Columbia, Legislation permitting pharmacists to refill medications before the expiration of the waiting period between refills has passed the Council and sent to Mayor Bowser (D) for signature. This measure allows pharmacists to authorize and dispense medication refills before the expiration of the waiting period between refills under protocols issued by the Board of Pharmacy and the Board of Medicine.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Florida
The Board of Pharmacy published a final rule to amend regulations under FAC 64B16-31 to update “smoking cessation” with “nicotine dependence” on the list of chronic health conditions for which a certified pharmacist may provide patient care services. The rule is effective April 29, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Human Services issued Informational Letter No. 2228-MC-FFS reminding pharmacy providers to bill the appropriate entity for Medicaid pharmacy claims. Claims for Medicaid members enrolled in a managed care organization (MCO) should be billed to the appropriate MCO or their corresponding PBM to which a member is assigned. An updated pharmacy billing reference sheet has been included in the Informational Letter.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
MedImpact gave this presentation that has details on the July 1, 2021 transition to a Single PBM in Medicaid as a result of the passage of SB 50 of 2020. It also includes a timeline and contact information for the MCOs.
Also in Kentucky, the Department of Medicaid Services is in search of a Pharmacy Director as Dr. Jessin Joseph has departed. Click here for more information or to apply.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Mississippi
The Board of Pharmacy published a final rule to adopt regulations under Title 30, Part 3001, Article XLVIII, to establish standards and procedures for delivering telepharmacy services. The rule specifies system requirements for monitoring the dispensing of prescription drugs and provides for related drug use review and patient counseling services by an electronic method including audio, video, still image capture, and store and forward. The rule is effective May 13, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Missouri
The Board of Pharmacy approved a final rule effective May 30, 2021, allowing pharmacy technicians to administer vaccines authorized by the federal Department of Health and Human Services during the coronavirus (Covid-19) pandemic. The rule currently is in effect as an emergency rule, expiring June 8, 2021.
Also in Missouri, the Department of Commerce and Insurance announced that the pharmacist’s statewide standing orders for naloxone dispensing as well as the COVID-19 vaccines (Pfizer and Moderna) previously signed by Dr. Williams have been rescinded because he resigned. The new statewide standing orders are signed by the authorizing physician, Dr. George Turabelidze, MD. The revised orders are available on DHHS’s website and the Board’s COVID-19 webpage.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The meeting materials for the next meeting of the Drug Utilization Review (DUR) Board on May 11, 2021, have been posted.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Carolina
The Board of Pharmacy published a proposed rule to amend regulations under 21 NCAC 46 to require pharmacies to report information on compounded drugs to the National Association of Boards of Pharmacy’s e-Profile Connect system. The rule would implement the memorandum of understanding with the secretary of Health and Human Services on the distribution of compounded drug products. The rule also would update information on accessing U.S. Pharmacopeia compounding standards. A hearing is scheduled for June 15, 2021, via webcast and teleconference. Comments are due June 15, 2021.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Ohio Department of Medicaid (ODM) announced the selection of six health care organizations that will provide managed care services starting in 2022. Additional information about the MCO announcement can be found in this press release and supplemental briefing documents. Further information about the planned reforms to and administration of the managed care program can be found at:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
Senator Judy Ward, RN, (R) has introduced SB 511. The bill is a joint NACDS/PACDS initiative that would update the state’s Pharmacy Practice Act to allow trained pharmacists, interns, and technicians to immunize the full CDC schedule to a person aged 3 and above.
Also in Pennsylvania, the Department of Human Services published a bulletin announcing that the COVID vaccine reimbursement rate was increased to match the revised Medicare rate of $40 per dose, effective March 15.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Texas
Big news at the Capitol this week is what to do about Medicaid expansion which will be part of the discussion as the House debates the state’s $246B budget proposal. President Biden’s action rescinding the 1115 Waiver authorized reimbursements to hospitals, nursing homes and mental health providers for patients without insurance came as quite a surprise to lawmakers. Texas has the highest number of uninsured in the nation. Among the several Medicaid expansion bills filed, none have been heard.
Also in Texas, the Health and Human Services Committee is seeking candidates to serve on the Value-Based Payment and Quality Improvement Advisory Committee. Anyone interested should review the linked application letter to find out who the committee is seeking as representatives and if you qualify; click on the application linked here to apply to be on the committee.
Also in Texas, the Senate Health and Human Services Committee held a hearing on April 21st on SB 2195 by the Chair Sen. Kolkhorst, legislation NACDS supports that protects patients who receive prescription drug benefits through a commercial health plan subject to Texas Department of Insurance (TDI) oversight. The bill also ensures patient choice, prevents self-dealing, and prohibits clawbacks. The Committee Substitute to SB 2195 was reported favorably by a 6-0 vote.
Lastly in Texas, NACDS launched two RxIMPACT alerts urging members to call members of the House Public Health Committee asking them to vote YES on HB 678 expanding access to immunizations and HB 2049 allowing pharmacists to furnish medications according to the result of a positive CLIA-waived test for acute conditions such as flu and strep throat.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Health Care Authority issued a final rule effective May 1, 2021, requiring providers to agree that all claims for Apple Health clients in fee-for-service and managed care are subject to 340B standards as part of participation in the 340B drug pricing program.
Also in Washington, the Office of the Insurance Commissioner extended two emergency orders until May 16, 2021, that are of interest to pharmacies.
- Notice extending the Emergency Order 20-01 requiring health insurers to waive copays and deductibles for coronavirus (Covid-19) testing. The order also requires insurers to allow a one-time early refill for prescription drugs; suspend 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.
- Notice extending Emergency Order 20-06 concerning insurance coverage for COVID-19 diagnostic testing prohibits all health carriers from balance billing for COVID-19 diagnostic testing processed by out-of-network laboratories, when determined to be medically necessary. The order also requests that insurers notify the agency if out-of-network laboratories submit claims but have not published a cash price or fail to accept such a price.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Effective May 1, 2021, the COVID-19 related universal prior authorization (PA) number will no longer be accepted for pharmacy overrides related to the three-month maintenance supply program. The universal PA will continue to work for claims associated with COVID-19 in other allowances (other than the three-month maintenance supply program) as described in the March 17, 2020 ALERT which can be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
On February 19, the Board of Pharmacy adopted regulation changes in Title 12, Chapter 52 of the Alaska Administrative Code. The final rule of the Board of Pharmacy refines the requirements for registration with the prescription drug monitoring program (PDMP) controlled substance prescription database, clarifies the requirements for registration by pharmacists before dispensing schedule II, III, or IV controlled substances under federal law, in particular clarifying the mechanism for out-of-state pharmacists to obtain a registration exemption and for those same pharmacists to meet registration requirements before dispensing controlled substances in this state and to clarify that a “prescriber” would be required to register within 30 days after initial licensure or registration with the DEA, whichever is later. These changes will be printed in Register 238, July 2021 of the Alaska Administrative Code. The rule is effective May 6, 2021.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
The Division of Pharmacy Services issued a final rule effective April 16 adding six opioid substances, four depressants, and two synthetic cathinones to Schedule I. The rule also adds three opioid analgesics to Schedule II, three mood-altering substances to Schedule IV, two substances to Schedule V and modifies Schedule VI removing FDA-approved cannabidiol substances from Schedule V.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
NACDS and the California Retailers Association submitted a joint letter to the Assembly Business and Professions Committee in support of AB 1328, legislation allowing pharmacists to perform all CLIA-waived tests.
Also in California, the Board of Pharmacy’s teleconferenced Licensing Committee’s April 21, 2021, meeting agenda and meeting materials have been posted along with information to participate. Also, the teleconferenced Enforcement and Compounding Committee’s April 22, 2021, meeting agenda has been posted along with information to participate.
Also in California, the Division of Workers’ Compensation’s Pharmacy and Therapeutics (P&T) Committee will meet on April 21, 2021, from 12:30 to 2:30 p.m. via video/audio conference only. To attend the meeting via video conference, please use the P&T Meeting Link. To join the meeting via teleconference, please use the call-in phone number: 1 (619) 407-9860 and enter phone conference ID: 520 391 953#.
Also in California, on April 1, the online attestation period opened for fee-for-service Medi-Cal pharmacy providers seeking the higher of two professional dispensing fees as part of the reimbursement for covered outpatient drugs. Medi-Cal pharmacy providers should have received a communication that includes the URL for the online attestation portal, as well as a unique login ID and password, by email, fax, or mail. If you have not received this communication, please call the Attestation Survey Hotline at 1-844-294-9982 or email CODSurvey@mercer.com. The attestation period for the 2020 calendar year is open until 11:59 pm April 30, 2021, and no attestations will be accepted after that time. The attestation for the 2020 calendar year reporting period determines the professional dispensing fee component of the pharmacy claim reimbursement for claims with dates of service from July 1, 2021, through June 30, 2022. For additional information, providers can refer to the Pharmacy Provider Self-Attestation FAQs or may call the Attestation Survey Hotline at 1-844-294-9982, or email their questions to CODSurvey@mercer.com.
Also in California, Medi-Cal Rx Transition and Resources Training announced three sessions covering important Medi-Cal Rx changes for pharmacy providers and prescribers. For registration, all the training sessions are posted on the Education & Outreach Calendar within the Saba Learning Management System (LMS); you must be logged into the User Administration Console (UAC) to access the Education & Outreach Calendar in Saba.
Lastly in California, the Board of Pharmacy is beginning the development of its new strategic plan and is seeking stakeholder feedback. The Department of Consumer Affairs, SOLID Planning Solutions (SOLID), is assisting the Board with its strategic planning process. Completed surveys will provide input as to how the Board is doing by identifying strengths, challenges, and current trends to consider for the future direction of the Board. All responses are anonymous. This survey will be open until April 30, 2021. For your convenience, NACDS is providing a PDF file of the survey.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
Florida Medicaid will continue to align with the Medicare vaccine administration rates. These rates were updated by the Centers for Medicare and Medicaid Services effective March 15, 2021. COVID-19 vaccines administered with a date of service on or after March 15, 2021, must be paid at the new rates. All guidance applies to both the fee-for-service and Statewide Medicaid Managed Care delivery systems unless otherwise stated.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.