In The States – Page 136 – Weekly news about states

Ohio

As you are aware, Ohio Medicaid (ODM) implemented the Single PBM, Gainwell, at Midnight on October 1. NACDS has been working with members, ODM and Gainwell daily to provide solutions as they work through technical issues causing denials, many of which have since been resolved or temporarily patched over. To report any major system issues, please use the dedicated email that Gainwell/ODM is monitoring in real-time. If you need NACDS’ assistance to emphasize significant issues, please contact Jill McCormack.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Erica Joyner2022-10-07T10:40:24-04:00October 7, 2022|Ohio|

Pennsylvania

Gov. Tom Wolf (D) issued a news release this week announcing that the Naloxone Standing Order has been expanded to include the 2 Dose Formulation and encouraging patients to bring a copy of the standing order to pharmacies to request the drug. NACDS reminds members that the PA Naloxone Copay Assistance Program will reimburse pharmacies up to $75 for patient copays when the patient is hesitant to pick up the prescription due to cost. For practical operational reasons, the claim must be adjudicated on the current PACE Program system. However, a claim for ANY insured patient regardless of what type of insurance they have – commercial or public – qualifies. There are no criteria to proving financial hardship on the pharmacy because access is the point of the program.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

Erica Joyner2022-10-07T10:38:19-04:00October 7, 2022|Pennsylvania|

Texas

The Drug Utilization Review Board posted the agenda for October 21 meeting. Refer to the Texas Drug Utilization Review Board Handbook for the instructions about submitting written materials to the board before the meeting and public testifying on the day of the meeting.

Also in Texas, the Health and Human Services Commission (HHSC) updated the July 2022 Medicaid Preferred Drug List on September 28 and provided the following updates:

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Erica Joyner2022-10-07T10:37:24-04:00October 7, 2022|Texas|

Washington

The Pharmacy Quality Assurance Commission (PQAC) is conducting a survey to assess current pharmacy practices pertaining to accessible labeling for both patients with visual and/or print disabilities and patients who require that prescription information be translated into another language besides English. The survey also includes whether such options are already made available, and what technological, financial or resource-based obstacles prevent such options from being offered. Any licenses are strongly encouraged to participate in the survey.

Also in Washington, the fourth quarter Preferred Drug List (PDL) has been posted to the Reports webpage. This PDL is used by Uniform Medical Plan and the Department of Labor and Industry.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Erica Joyner2022-10-07T10:28:50-04:00October 7, 2022|Washington|

Arkansas

Gov. Asa Hutchinson (R) appointed Mark White as the Secretary of the Department of Human Services, replacing Cindy Gillespie.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Michael Silber2022-09-30T12:45:20-04:00September 30, 2022|Arkansas|

California

The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.  

Submission of Pricing Prior Authorization for Brand Medically Necessary Medications: Dispense as Written (DAW 1) (September 29)
Enteral Nutrition: Powder Dispensed in Packets, Billing Units Reminder (September 27)
CoverMyMeds: Provider Support (September 27)
Enteral Nutrition Update: Changes to the List of Covered Enteral Nutrition Products, Retroactive to September 1, 2022 (September 23)
Medi-Cal Rx Weekly Wrap-Up for September 16-22 (September 23)

Also in California, this week, Medi-Cal posted “Medi-Cal Provider “Coffee Break” Event.”

Finally in California, the Board of Pharmacy posted the agenda for the Enforcement and Compounding Meeting scheduled for October 4.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

Michael Silber2022-09-30T12:44:48-04:00September 30, 2022|California|

Florida

As previously announced in a provider alert dated June 28, 2022 Provider Alert, the Agency for Health Care Administration (Agency) has been implementing Referring, Ordering, Prescribing, and Attending (ROPA) requirements as directed by the 21st Century Cures Act (Cures Act) and by the Centers for Medicare and Medicaid Services (CMS). Previous provider alerts on National Provider Identifier (NPI) requirements for ROPA providers can be found on the Agency’s website in the Provider Message Archive. Providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b).

All Fee-For-Service claims submitted January 1, 2023, or after from a non-exempt provider type that does not have a ROPA provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed below, all other provider type claims must have a ROPA provider identified by NPI on the claim for reimbursement by Florida Medicaid.

In a provider alert dated June 28, 2022, the Agency previously set the effective date as October 1, 2022. To allow providers more time to prepare, we have extended the effective date to January 1, 2023. In addition, the Agency has continued to evaluate the effected provider types and has added several types to the exempted list.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Michael Silber2022-09-30T12:43:44-04:00September 30, 2022|Florida|

Indiana

Gov. Eric Holcomb (R) administration that the state has $6.1 billion in reserve following the closeout of its fiscal year, having collected $353 million more in revenue than the current budget needs. Because of the new law passed during the special session, the first one billion dollars in excess goes to paying down debt in the teacher pension fund. The remaining surplus will be disbursed to taxpayers as part of the Governor’s inflation relief plan.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Michael Silber2022-10-04T13:11:53-04:00September 30, 2022|Indiana|

Louisiana

The Board of Pharmacy Regulation Revisions Committee will be meeting on October 11 at their office in Baton Rouge to discuss these regulatory proposals.

Also in Louisiana, the Department of Insurance Office of the Commissioner promulgated Regulation 122 defining the roles and responsibilities solely within the purview of pharmacy benefit managers and pharmacy services administrative organizations.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Michael Silber2022-09-30T12:42:22-04:00September 30, 2022|Louisiana|