Kentucky

The Board of Pharmacy held a “special called” meeting on January 4 where they withdrew a new regulation and proposed rule amendments regarding out-of-state pharmacies. The rules would have created a new non-resident pharmacist license requirement for out-of-state pharmacists and stricter requirements for an out-of-state pharmacy to acquire a non-resident pharmacy permit. At the meeting, it was stated that the withdrawal was due to the voluminous number of public comments they received.  

Following this, two Senate bills were introduced last week: 

  • SB 36 would reorganize the Board of Pharmacy to assign seats to different practice settings and make appointments subject to Senate confirmation. 
  • SB 37 would prohibit an out-of-state pharmacy permit holder from being required to have their pharmacists licensed, except for the Pharmacist in Charge (PIC). 

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

2023-01-13T12:07:53-05:00January 13, 2023|Kentucky|

Louisiana

Effective January 1, 2023, the Louisiana Medicaid Pharmacy Program expanded to include a sixth managed care organization (MCO), Humana Healthy Horizons. For more information on verifying eligibility and processing claims, go to Pharmacy Facts. 

Also in Louisiana, effective January 1, 2023, Medicaid Fee-for-Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs), will implement a point of sale dispensing of contraceptives allowing a 6-month supply when the recipient has a previous history of contraceptive agents. The allowance applies to pharmacy claims submitted to FFS and MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and UnitedHealthcare). 

Finally in Louisiana, the 2023 Naloxone standing order was updated effective January 1, 2023 

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

2023-01-13T12:07:18-05:00January 13, 2023|Louisiana|

Massachusetts

Please see these updated Provider Bulletins here (2022) and here (2023) regarding Coverage and Reimbursement Policy for Coronavirus Disease 2019 (COVID-19) Bivalent Vaccine Doses and Pre-exposure Prophylaxis, Extension of Flexibilities for Prior Authorization of Formula, Pediatric Immunization Vaccine / Administration SL Modifier Change and Managed Care Entity Bulletin 95: Access to Health Services through Telehealth Options for Members Enrolled in Managed Care Entities. To view and download other MassHealth publications visit Provider Publications. 

Also in Massachusetts, on January 11, 2023, the Massachusetts Public Health Council approved redrafted regulations at 105 CMR 700.00 which will authorize pharmacy technicians to administer influenza and other immunizations as designated by the Department of Public Health. Regulations also reduce the age of persons from 9 to 5 who may receive a vaccination at a pharmacy. DPH also adopted an amendment that will allow a pharmacist to administer the first dose of a controlled substance for the treatment of mental health and substance abuse disorders. These regulations are expected to be published in the next two weeks. 

Also in Massachusetts, regarding Long Term Care Facilities and Pharmacies, 105 CMR 721.070(A)(11) provides an exception to the e-prescribing mandate for prescriptions written for long term care (LTC) residents. This exception was set to expire on January 1, 2023, or such later date as determined by the Department. Considering the Centers for Medicaid and Medicare Services (CMS) extending, from January 1, 2023, to January 1, 2025, its implementation of the requirement to e-prescribe Medicare prescriptions in LTC facilities, the Department will follow suit and hereby extends, until January 1, 2025, the exception for prescriptions issued to LTC resident under 105 CMR 721.070(A)(11). Those LTC facilities with e-prescribing in place are encouraged to continue using it.  

Please see 105 CMR 721 (mass.gov) and accompanying 2019 ePrescribing Manual for details.  

Finally in Massachusetts, while Amoxicillin Oral Powder for Suspension remains on the FDA drug shortage list, Board-licensed pharmacies may compound this product from solid oral dosage forms provided that the FDA guidance on compounding beta-lactam products in shortage is followed to mitigate the potential risk of cross-contamination.  

Once the shortage has resolved, use of commercial products must resume.  

Please review the Board’s Policy on Compounding Copies of Commercially Available Drugs.  

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2023-01-13T12:06:37-05:00January 13, 2023|Massachusetts|

Michigan

NACDS reminds members that pharmacists can prescribe self-administered hormonal birth control under delegated authority, including oral contraceptives, the patch, and the ring, by opting into the program. The change happened under an interpretive statement issued by the state’s Licensing and Regulatory Affairs Department (LARA) under direction of a previous executive directive 2022-05 issued by Gov. Gretchen Whitmer (D) in May of 2021. Pharmacists must enter into a delegation agreement; a sample delegation agreement is available on LARA’s website. The governor’s executive directive in May instructed state departments and agencies to identify and assess opportunities to increase protections for reproductive health care.

Also in Michigan, on October 3, LARA issued a notice that the state will formally begin enforcing Michigan’s 2020 e-prescribing law on January 1, 2023. Though the law was originally to take effect in 2021, it included a provision allowing Bureau of Professional Licensing to delay enforcement until the federal Centers for Medicaid and Medicare (CMS) began enforcing the mandate on Part D prescription drug programs. LARA also released an Application for waiver of electronic prescribing requirements form for prescribers and posted an FAQ document. Note that pharmacists are not required to verify that a prescriber qualifies for a waiver when filling paper prescriptions.  

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

2023-01-13T12:05:51-05:00January 13, 2023|Michigan|

Missouri

The legislature convened on January 4, 2023. Several PBM reform bills have been filed, including SB 402/HB 198 and SB 26/HB 197. Also filed were two bills expanding the Pharmacy Practice Act related to the administration of medication by pharmacist including HB 331 and SB 41.

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

2023-01-13T12:04:56-05:00January 13, 2023|Missouri|

New York

On January 17, from 1:00 p.m. – 3:00 pm, the Department of Health (DOH) is hosting the next in its series of monthly stakeholder informational webinars about the transition of the pharmacy benefit from Medicaid Managed Care to Medicaid Fee for Service (NYRx). Registration is required in order to access the meeting links. Presentations from past meetings are available on the transition website. 

Also in New York, the DOH issued an update to the Medicaid Fee for Service Program “Dispense Brand Name Drug When Less Expensive Than Generic” list effective January 19. Additionally, DOH published an updated standing order for Naloxone under the signature of Dr. Sharon Stancliff. 

Finally in New York, as 2022 ended, Gov. Kathy Hochul (D) signed several bills important to pharmacy practice into law, including: 

  • S4870B authorizing pharmacists to administer certain long acting injectables (Note: rules will need to be promulgated and a new bill for 2023 with minor technical changes to the law has been agreed to.) 
  • A7469 allows for 30-day emergency refills 
  • A187 permits pro-rated cost sharing on short fills and maintains the full dispensing fee to enable medication synchronization in the state’s Medicaid program 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2023-01-13T12:04:24-05:00January 13, 2023|New York|

Montana

LC 1633, related to 340B, was a prefile for the 2023 state legislative session. As drafted, PBMs or health insurers may not:  

  • Prohibit federally certified health entities or pharmacies from participating in the insurer’s network;  
  • Reimburse a federally certified health entity or pharmacy differently than reimbursing other similarly situated pharmacies;  
  • Require a claim or a drug to include a modifier to indicate that the drug is a 340B drug, unless the claim is for Medicaid payment; or 
  • Create restrictions or impose additional charges on patients who choose to receive drugs from a federally certified health entity or pharmacy  

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

2023-01-13T12:02:13-05:00January 13, 2023|Montana|

North Carolina

This is advance notice of reprocessing information that will be sent to affected providers on or about January 17. Due to a system error with the generic dispensing fee, pharmacy claims were paid incorrectly. The affected claims will be reprocessed to apply the correct rate. This reprocessing notice applies to pharmacy claims that were processed and paid in NCTracks from November 1, 2013, through April 7, 2014. The affected claims will be systematically reprocessed as adjustments. No provider action is required. Applicable claims will be reprocessed in the February 7 check write. For more information, visit NCTracks here.  

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

Ohio: The Ohio Department of Medicaid (ODM) and Gainwell Technologies, the Single Pharmacy Benefit Manager, are continuing the re-implementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations, and does not apply to those patients who have previously taken the drug supported by recent claims history prior to January 17. Phase 2 of reimplementation will begin on January 17 and encompass the following drug classes:  

Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see the products that require prior authorization. Prior authorizations may be submitted via phone, fax, mail and the SPBM portal. Additional prior authorizations are planned for reimplementation in a similar, incremental fashion during the first quarter of 2023. For questions, contact the Gainwell Help Desk at 1-833-491-0344.  

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

2023-01-13T12:01:38-05:00January 13, 2023|North Carolina|

Pennsylvania

Gov.-elect Josh Shapiro (D) has named Valerie Arkoosh, an anesthesiologist and chair of the Montgomery County Commissioners, as his Secretary of the Department of Human Services. Arkoosh led her county’s response in the early days of the coronavirus pandemic, which elevated her to the spotlight as Montgomery County was in the epicenter of the virus’ spread. She also has been a professor of anesthesiology and obstetrics and pitched an unsuccessful run for Congress in 2014 before being re-elected to the County Commission. He also named: 

  • Secretary of Health: Debra Bogen, a pediatrician, and the director of the Allegheny County Health Department. 
  • Secretary of Drugs and Alcohol: Latika Davis-Jones, senior director of behavioral health at Highmark Wholecare, a Medicaid managed care provider in southwest Pennsylvania. 
  • Secretary of Aging: Jason Kavulich, Lackawanna County Director of Agency on Aging. 
  • Insurance Commissioner: Mike Humphreys, who has held the role temporarily since last spring. 

Also in Pennsylvania, the Department of Human Services (DHS) issued a Medicaid bulletin announcing they will be reinstating pre-COVID provider enrollment requirements effective February 27, 2023; while the PACE Program announced their Part D pharmacy benefit plan partners for 2023. 

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

2023-01-13T12:00:54-05:00January 13, 2023|Pennsylvania|

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