Latest edition of MassHealth Pharmacy Facts has been distributed to MassHealth Pharmacy providers.
Also in Massachusetts, MassHealth has issued the attached corrected bulletin #352 relative to the reporting and payment of overpayments received from MassHealth. The original bulletin was issued in September 2022.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Department of Health and Human Services (DHHS) posted the COVID-19 Fee Schedule Bivalent Booster Updated (revised 10.27.2022).
Also in Nebraska, the DHHS announced Medicaid’s next COVOID update call will be held on November 2 at noon (Central). To join the call, dial 408-418-9388 (access code) 2492 610 1342 or use the meeting link:
https://sonvideo.webex.com/sonvideo/j.php?MTID=m3aab184252403e62a6ff312be38e9d54
Also in Nebraska, the Board of Pharmacy posted its agenda for the November 7 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
To help providers, the Department of Health and Human Services updated its Provider Guidance on Therapeutics to include detailed up-to-date information. Providers are encouraged to read the guidance. More information is available on the Therapeutics Information for Providers webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
NACDS will be attending the annual meeting for the Community Pharmacy Association of New York in Albany on November 15th. At this meeting, the priorities and strategies for the 2023 legislative session will be reviewed.
Also in New York, our comments, that were reviewed by New York members will be submitted to the Department of Financial Services for the October 31st deadline. If your company is also submitting your own comment letter, please be sure to place PBM2022-06 in the subject line.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
This week, Ohio Medicaid announced the payment schedule for the Supplemental Managed Care Dispensing Fee and that the fee has been increased due to the compressed schedule of payments. The payment schedule is:
Payment 5 – Between November 1 – 15, 2022 (July – Sept 2022 claims)
Payment 6 – Between February 1 – 15, 2023 (Oct – Dec 2022 claims)
Payment 7 – Between May 1 – 15, 2023 (Jan – March 2023 claims)
Payment 8 – No later than August 15, 2023 (April – June 2023 claims)
Note that the November payment will be issued by the Medicaid MCOs (Managed Care Organizations) and, as in the past, will be included in your weekly claim payments. However, the balance of the payments will come from Gainwell, the SPBM (Single Pharmacy Benefit Manager), as a separate payment. The FAQ document includes more detail.
Also in Ohio, Medicaid has prepared a toolkit for providers to prepare for the expiration of the federal Public Health Emergency (PHE). The materials are focused on the “unwinding” patient eligibility that will result at the end of the PHE.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Oregon State Pharmacy Association announced the results of its PBM study conducted by 3 Axis Advisors to review reimbursement trends between payers and retail pharmacies between 2019 and 2021.
Also in Oregon, the Board of Pharmacy posted its agenda for its Strategic Planning Meeting scheduled to be held on November 10.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
On the last day of the 2021-22 session, a PBM transparency bill backed by NACDS and PACDS (Pennsylvania Association of Chain Drug Stores), passed the Senate unanimously and is on its way to Gov. Tom Wolf (D) for signature. HB 1630 allows the Auditor General access to PBM data in the Medicaid Managed Care Program to perform audits. Notably, the bill was amended in the Senate Health Committee to repeal the provision in Section 1121.53(c) of 55 Pa. Code that limits payment for prescriptions in Medical Assistance to a 34-day supply or 100 units.
Also in Pennsylvania, the Department of Human Services released the final regulation for IRRC No. 3308 – Interrelationship of Providers (14-549) allowing providers to co-locate. Providers who received a waiver of the previous regulation will still be operating under that waiver until the final form regulation takes effect. The regulation will be considered at the Independent Regulatory Review Commission (IRRC) meeting on December 8 and comments are accepted until 48 hours prior to the meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Please find an ALERT describing the addition of state-licensed pharmacist Paxlovid prescribing to eligible patients in accordance with the FDA. This ALERT has been disseminated to all enrolled pharmacies.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
Also in California, Medi-Cal posted the following:
Also in California, Gov. Gavin Newsom (D) announced the State of Emergency and the associated Executive Orders N-39-20 and N-75-20 will end on February 28, 2023. The Department of Consumer Affairs subsequently posted that upon the State of Emergency ending, active waivers that were used under the authority of the State of Emergency and Executive Orders will also expire. For future updates, check the DCA waiver webpage or the Board of Pharmacy website.
Finally in California, the Board of Pharmacy posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.