In The States – Page 142 – Weekly news about states

Kentucky

The Board of Pharmacy has filed an emergency and ordinary amendment to allow pharmacists to prescribe and receive Medicaid reimbursement for Paxlovid. Specifically, the amendment removes the list of specific conditions that require a Board-approved protocol for pharmacists to be authorized to treat patients with illnesses. Instead, the regulation would allow a pharmacist to utilize any protocol approved by the board to provide treatment services. This emergency amendment will allow for any prescriber–approved protocol to be reviewed for approval by the Board of Pharmacy. If the regulation is approved, the physician Director of Medicaid Services can also sign a prescriber–approved protocol for any pharmacist to initiate the dispensing of Paxlovid for Medicaid patients. Additionally, the board approved a new board authorized protocol for Paxlovid. The emergency regulation was effective immediately, but the ordinary version must be go through the promulgation process with the Board. NACDS expects the physician community to oppose this regulation and encourages members to join us in submitting supportive comments by September 30. Further detail and contact information for comments are on the regulation webpage.

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

Michael Silber2022-09-16T09:50:33-04:00September 16, 2022|Kentucky|

Louisiana

The Department of Health (LDH (Louisiana, the Department of Health)) Medicaid Pharmacy Facts includes detailed information on Medicaid’s Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) coverage and reimbursements for flu and COVID booster.

Effective September 15, 2022, enrolled pharmacies will be reimbursed for the influenza vaccines and administration of the vaccines when given to Medicaid recipients, who are 19 years of age and older when the administering pharmacist is an enrolled Medicaid provider. The cost of the vaccine will not be reimbursed for recipients under the age of 19, only the administration fee will be reimbursed, as these vaccines are available through the Louisiana Vaccines for Children (VFC) program. The Louisiana Board of Pharmacy rules and regulations allow a vaccinating pharmacist to administer the influenza vaccine to individuals seven years of age and older.
On September 23, 2022, with an effective date of August 31, 2022, the Louisiana Medicaid’s Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) are covering the bivalent COVID-19 vaccine booster, with Emergency Use Authorization (EUA). The federal government covers the cost of the COVID-19 vaccine. Therefore, Louisiana Medicaid will reimburse enrolled pharmacies the administration fee only. Coverage for the Pfizer, Janssen (Johnson & Johnson), and Moderna COVID-19 primary vaccine series will continue.
Louisiana Medicaid is hosting a series of provider webinars regarding the upcoming Provider Enrollment deadline.

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

Michael Silber2022-09-16T09:49:44-04:00September 16, 2022|Louisiana|

Mississippi

Effective July 1, 2022, the Mississippi Division of Medicaid (DOM) reestablished payment methods for the ingredient costs of prescription drugs that existed prior to the July 1, 2021 rate freeze. This change removed the freeze for dates of service on or after July 1, 2022. On 8/22/2022, Conduent will begin adjusting claims with dates of service of 7/1/2021 through 6/30/2022 to reflect the ingredient cost of the drug in effect on the claim’s date of service.

Also in Mississippi, the Pharmacy Association will hold its 2022 Consultant Seminar on October 13, 2022, 8:00 a.m. – 5:00 p.m. Please visit their website for more information or Contact Mindy Phillips at mindy@mspharm.org if you have any questions or need assistance.

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

Michael Silber2022-09-16T09:49:04-04:00September 16, 2022|Mississippi|

Nebraska

The Department of Health and Human Services (DHHS) announced the next COVID Medicaid Provider call will take place on October 5 at noon (Central). Call details will be posted at this website one week before the call.

Also in Nebraska, the DHHS issued a News Release, titled “Nebraska Medicaid To Interview Bidders For New Managed Care Contracts.”

Finally in Nebraska, the DHHS posted the following:

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

Michael Silber2022-09-16T09:48:26-04:00September 16, 2022|Nebraska|

Ohio

NACDS reminds members that Gainwell, the Ohio Medicaid Managed Care Single Pharmaceutical Benefits Manager (SPBM), will being offering pharmacies training on using the web portal on September 19. Registration instructions can be found on the Single PBM page. Select the selecting the provider resources tab, then clicking on “SPBM Web Portal Training.” Gainwell will be processing all Medicaid managed care claims beginning on October 1, 2022.

Also in Ohio, the Board of Pharmacy has issued draft regulations allowing registered and certified pharmacy technicians to vaccinate. The rule makes technician immunization authority consistent with Ohio’s current pharmacist immunization authority as it relates to age and vaccine type, per passage of House Bill 6 of 2021. NACDS intends to comment on this rule. Please send Jill McCormack your comments by October 3.

Finally in Ohio, Medicaid and Myers & Stauffer have announced an extension of the due date for the 2022 mandatory Cost of Dispensing Study to September 21 and have stated in a letter to pharmacies that this will be the final extension of the survey due date.

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

Michael Silber2022-09-16T09:47:47-04:00September 16, 2022|Ohio|

Oregon

The Board of Pharmacy posted the agenda for the Public Health & Pharmacy Formulary Advisory Committee to be held on September 21. Please note agenda items related to protocol development and proposed protocol revisions.

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

Michael Silber2022-09-16T09:47:06-04:00September 16, 2022|Oregon|

Pennsylvania

Legislation that would allow the state Auditor General to have access to PBM’s data from the Medicaid Managed Care program passed the House unanimously this week. House Bill 1630, sponsored by Rep. Jonathan Fritz (R), now goes to the Senate for consideration.

Also in Pennsylvania, the Board of Pharmacy has posted the agenda for their September 27th meeting.

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

Michael Silber2022-09-16T09:46:35-04:00September 16, 2022|Pennsylvania|

South Carolina

Effective for dates of service on or after Sept. 15, 2022, the South Carolina Department of Health, and Human Services (SCDHHS) will expand coverage for additional pneumococcal immunizations for Healthy Connections Medicaid members 19 years of age and older under the pharmacy and medical benefit.

SCDHHS will reimburse providers for the administration of the immunizations in accordance with the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule for the following Healthcare Common Procedure Coding System (HCPCS) codes:

Pneumococcal 15-valent conjugate vaccine (PCV15): HCPCS Code 90671
Pneumococcal 20-valent conjugate vaccine (PCV20): HCPCS Code 90677

The new codes will be reflected on the Physicians Fee Schedule and updates to the Physicians Services provider manual will be available by Sept. 15, 2022.

Pharmacy reimbursement utilizes the standard basis of payment for the fee-for-service pharmacy benefit at the lowest of:

The actual acquisition cost (AAC) plus a professional dispensing fee (PDF) of $10.50;
The state’s maximum allowable cost plus a PDF of $10.50; or,
The usual and customary charges to the public.

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

Michael Silber2022-09-16T09:45:59-04:00September 16, 2022|South Carolina|

Texas

The Health and Human Services Commission’s (HHSC) Executive Commissioner Cecile Erwin Young announced that Dr. Jennifer Shuford will serve as interim commissioner of the Texas Department of State Health Services (DSHS), effective October 2022, replacing Dr. John Hellerstedt who is retiring from state service. Shuford currently serves as chief state epidemiologist at DSHS. She is also a member of the Texas Medical Association, where she serves as a consultant to TMA’s Committee on Infectious Diseases.

Also in Texas, the September draft specialty drug list has been posted. Comments are due by September 22, 2022.

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

Michael Silber2022-09-16T09:45:20-04:00September 16, 2022|Texas|