The Department of Health and Human Services posted an agenda for the Nebraska Medicaid DUR (Drug Utilization Review) Board Meeting to be held on July 12.
Also in Nebraska, a Technical Committee Meeting for the Credentialing Review (407) Pharmacy Technician is scheduled for June 28 and an agenda has been posted.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Governor Michelle Lujan Grisham (D) signed an executive order creating a Prescription Drug Task Force directed to identify ways to expand access and affordable pricing for medications. The EO (Executive Order) directs its members to analyze and report solutions to manage and minimize the cost of prescriptions for New Mexicans. Membership will include a New Mexico licensed pharmacist engaged in practice at an independent pharmacy, the Superintendent of Insurance, a licensed physician in New Mexico, a patient advocate, and an individual whose profession is in the health insurance industry.
Also in New Mexico, the Medical Assistance Division (MAD) of the New Mexico Human Services Department (HSD) is now requiring ALL prescribers, including pharmacists with prescriptive authority for Centennial Care members to enroll as a Medicaid Provider to continue to receive payment for prescriptions. Failure to enroll will result in denial, rejection, or recoupment of payment for prescriptions when written for Centennial Care Members effective November 12, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
On June 8, 2022, the New York State Department of Health in consultation with the Department of Environmental Conservation, announced the approval of two Drug Take-Back programs, proposed and operated by Inmar Rx Solutions, Inc. and MED-Project, LLC. Pursuant to Chapter 120 Laws of 2018, the New York State Drug Take Back Act (DTB) mandates that manufacturers establish, fund, and manage a New York State-approved drug take-back program(s) for the safe collection and disposal of unused covered drugs. Pharmacies of ten or more establishments within NYS and non-resident pharmacies that provide covered drugs to NYS residents by mail must implement such programs by providing consumers with a pre-approved method(s) of collection and disposal, free of charge to the consumer and pharmacy.
For more information on the Drug Take-Back programs to be operated by Inmar and MED-Project, visit their sites:
The press release can be found here: New York State Department of Health and Department of Environmental Conservation Announce Approval of Two Drug Take Back Programs
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
In response to questions posed to Medicaid (ODM) at the May Joint Medicaid Operations Committee (JMOC) meeting related to the implementation of the Single Pharmaceutical Benefits Manager, ODM issued a letter that contains further detail on the implementation timeline and other issues of import to members.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Department of Insurance issued Bulletin No. 5-2022 provides information to clarify what is required regarding a new law, SB (Senate Bill) 737 was codified into Title 36 § 6962 of the Oklahoma Statutes that includes new requirements which will have a significant impact on the Pharmacy Benefits Management industry. Because the law included a declaration of emergency, it took effect immediately on April 21st when signed by Governor Kevin Stitt (R).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The House Professional Licensure Committee will consider HB 2679 on June 20. The bill, introduced by the Majority and Minority Chairs of the Committee, represents a compromise agreement that would expand pharmacists’ immunization authority by allowing the administration of influenza and COVID vaccines down to age 5. Currently, pharmacists can only vaccinate children for flu starting at the age of 9.
Also in Pennsylvania, the Board of Pharmacy has posted the agenda for the June 28 meeting. Members can access the meeting virtually and log-in instructions are included in the agenda.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Senate Health and Human Services Committee will hold hearings on June 27 to examine the impact of state and federal pandemic policies-including agency guidance, licensing and regulatory actions, and health care industry policies-on patient care and treatment delivery.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Care Authority (HCA) Director Sue Birch selected Dr. Charissa Fotinos, who has been the interim state Medicaid Director since August of 2021, as the new state Medicaid Director. Dr. Fotinos will also continue to serve as HCA behavioral health medical director.
Also in Washington, effective July 1, 2022, the Health Care Authority (HCA) is publishing quarterly updates to many of the Apple Health billing guides. Billing guides are located on HCA’s Provider billing guides and fee schedules webpage.
Finally in Washington, the State Health Care Authority (HCA) is beginning the first step of making its Medicaid Management Information System (MMIS), known as ProviderOne, more flexible and modifiable. First, HCA is working to replace the existing Pharmacy Point of Sale (POS) system. The new Pharmacy POS solution will offer the latest functionality, features, and technologies to better meet the needs of Washington’s Medicaid clients.
On the day of go‐live, fee‐for‐service pharmacy claims will no longer be billable using our current processor control number (PCN) and bank identification number (BIN). HCA will provide the new PCN/BIN as the project gets closer to go‐live. After the initial implementation, HCA will be adding functionality for pharmacies and prescribers to submit prior authorization requests through a new, secure online portal.
Sign up for the Health Care Authority’s email list to receive future updates on this project, including the go‐live date and PCN/BIN changes. If you have questions, contact pharmacyposproject@hca.wa.gov.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Effective July 1, 2022, the Alabama Medicaid Agency will:
| PDL Additions | |
| Dexmethylphenidate ER (generic) | Cerebral Stimulants/Agents Used for ADHD (attention deficit hyperactivity disorder) (Long-Acting) |
| PDL Deletions | |
| Adhansia XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
| Focalin XR | Cerebral Stimulants/ Agents Used for ADHD (Long-Acting) |
For additional PDL and coverage information, visit the drug look-up site.
The Prior Authorization (PA) request form and criteria booklet should be utilized by the prescriber or the dispensing pharmacy when requesting a PA. The PA request form can be completed and submitted electronically on the Agency’s website.
Incomplete PA requests or those failing to meet Medicaid criteria will be denied. If the prescriber believes medical justification should be considered, the prescriber must document this on the form or submit a written letter of medical justification along with the PA form to Kepro. Additional information may be requested. Staff physicians will review this information.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.