The Prescription Drug Affordability Board (PDAB) posted a draft agenda for its October 16 meeting. Please note the discussion of “Policy recommendations for the Oregon Legislature” and SB 192 upper payment limit study. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Please see the October 2024 Provider Update from Medicaid. All previous provider updates may also be found online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy has issued guidance on the state of emergency regarding out-of-state pharmacies and emergency refills.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Gov. Bill Lee (R) issued an executive order allowing pharmacist to dispense a 30-day supply of medication (excluding controlled substances) without prior authorization for victims of Hurricane Helene. This order remains in effect until November 10. The Tennessee Pharmacy Association has compiled a list of resources and ways to support the impacted communities as relief efforts continue. Recent Department of Commerce and Insurance (TDCI) Bulletin 24-03 also provides for one early or replacement prescription refill per medication; see last bullet on page 2.
Also in Tennessee, the Tennessee Pharmacy Association requests your participation in the TennCare Diaper Program Survey. The feedback will provide data that will be shared directly with TennCare pharmacy leadership addressing reimbursement rates, administrative fees, successes and difficulties that pharmacy professionals have experienced since the diaper program launch.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Texas Pharmaceutical Initiative (TPI) Board established by HB 4990 (2023) submitted its business plan recommendations to Gov. Greg Abbott (R), the Legislature and the Legislative Budget Board on September 30. TPI’s goal is to provide greater, and more cost-effective access to prescription drugs and essential medical supplies to employees, dependents and retirees of public higher education systems; members of the Employees Retirement System of Texas (ERS); members of the Teacher Retirement System of Texas (TRS); individuals under the Texas Department of Criminal Justice or Texas Juvenile Justice Department; and individuals served by health and human services programs, including Medicaid and the Child Health Insurance Program.
Also in Texas, last month, the Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP announced that HHSC suspended its efforts to conduct pharmacy cost of dispensing and ingredient cost studies. The reason given was that “As in recent past legislative sessions, the 89th Legislature may choose to contemplate pharmacy reimbursement matters which could significantly influence how HHSC approaches and obtains necessary appropriations for pharmacy reimbursement in both fee-for-service and managed care settings.”
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Health Care Services posted the following alerts and weekly notice on the Medi-Cal Rx Web Portal:
Also in California, NACDS submitted a letter to the Board of Pharmacy expressing concerns with proposed rules updating the Board’s quality assurance program regulatory requirements. The primary concern is that these amendments could potentially put pharmacies that are members of Patient Safety Organizations (PSOs) at odds with the requirements set forth in the Patient Safety and Quality Improvement Act of 2005 (PSQIA) and recommended the Board further analyze these amendments. Additionally, we requested a one-year delayed implementation of this regulation to allow pharmacies sufficient time to update their policies and systems to comply.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Department of Healthcare and Family Services (HFS) recently released 2023 Q4 and 2024 Q1 payments for the Critical Access Pharmacy (CAP) Program. Due to the Change Healthcare System outage earlier in the year, the Q4 data was not complete, and the Q1 data was estimated, and both will be reconciled as part of the 2024 Q2 payments once all the data from the Medicaid managed care plans has been submitted.
HFS made the estimated payments to ensure CAPs received these important funds. Please note that new pharmacies who have never received CAP funds had no estimated payment available for Q1, and therefore did not receive an initial CAP payment. HFS will also reconcile these pharmacy payments when the Q2 payments are processed.
If you have any questions, please contact a pharmacy billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
Also in Illinois, the Department informed pharmacies that the 2024-2025 influenza vaccine National Drug Codes (NDCs) have been loaded to the Pharmacy Billing Management System (PBMS) and can now be billed.
To receive the vaccine administration fee, pharmacies billing the Medicaid fee-for-service (FFS) program should enter the administration fee amount in the Incentive Amount Submitted field (438-E3). If the value in this field exceeds $6.40, the maximum allowed by the Department of Healthcare and Family Services (HFS), the claim will only pay an administration fee of $6.40. If the value of the field is less than or equal to the HFS allowed amount, the system will pay the lesser of the two. The value ‘MA’ must be entered in the Professional Service Code field (440-E5) unless no administration fee is billed. The claim will reject if it is submitted with an incorrect value in one of these fields. If a claim is submitted with an NDC for an influenza vaccine, but neither of these fields is populated, no administration fee will be paid.
For managed care organization (MCO) claims, please contact the applicable MCO for billing instructions.
Questions should be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Department of Health and Human Services (HHS), Iowa Medicaid posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The latest Board of Pharmacy newsletter announced revisions to four statewide protocols effective July 24, 2024. The updated protocols include Acute Influenza Infection Chemoprophylaxis treatment, and three related to self-care, including diabetes testing and injections, over-the-counter (OTC) dietary supplements and OTC probiotics.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.