Washington
The Health Care Authority (HCA) revised the Apple Health (Medicaid) COVID-19 vaccine clinical policy and the Emergency COVID-19 fee schedules.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
On June 27, Gov. Gavin Newsom (D) signed SB (Senate Bill) 154 (Chapter 43) which includes language allocating $114.4 million to forgive the retroactive reduction of claims reimbursement for independent pharmacies in 2022-23. Another $28.4 million will be allocated in 2023-24. This was due to an error in the implementation of the actual acquisition cost reimbursement methodology for dates of service from April 1, 2017, to February 22, 2019, inclusive. On June 30, Gov. Newsom signed AB (Assembly Bill) 178 (Chapter 45) that directs the Department of Health Care Services to forego the recoupment of overpayments from independent pharmacies and defined “independent pharmacy” as a pharmacy owned by a person or entity who owns not more than 74 pharmacies in California. Also, on June 30, the Governor signed SB 184 (Chapter 47), the health trailer bill, that expands telehealth and exempts continuous glucose monitors and medication therapy management services from a 10 percent provider cut based on 2011 legislation.
Also in California, the Department of Consumer Affairs issued this waiver extension on July 11: DCA Waiver DCA-22-217 Order Waiving Restrictions on Pharmacists Independently Initiating and Furnishing Paxlovid to Individual Patients. The full waiver and a list of current waivers is available on the DCA website.
Also in California, the Board of Pharmacy recently communicated the following:
- Complaints about Pharmacy Performance Quotas
- July 18 at 9:00 a.m. – Licensing Committee Meeting Agenda and Meeting Materials
- July 18 at 1:00 p.m. – Legislation and Regulation Committee Meeting Agenda and Meeting Materials
- July 19 at 9:00 a.m. – Enforcement and Compounding Committee Meeting Agenda and Meeting Materials
- July 19 at 1:00 p.m. – Communication and Public Education Committee Meeting Agenda and Meeting Materials
Also in California, the Department of Health Care Services posted the following alerts on the Medi-Cal Rx Web Portal. Please note this week’s announcement about the postponement of implementation of NCPDP (National Council for Prescription Drug Programs) reject code 80 and the reminder about the July 31 deadline for all participating Medi-Cal Rx pharmacy providers and billers to submit a Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form to continue submitting electronic claims without interruption.
- Prescriber Advantages of Using CoverMyMeds® for Medi-Cal Rx Prior Authorization Requests (July 13)
- Update: Postponement of Implementation of NCPDP Reject Code 80 (July 12)
- Changes to Medical Supplies Reimbursement Methodology, Effective July 1, 2022 (July 8)
- Medi-Cal Rx Weekly Wrap-up for July 1-7 (July 8)
- Second Booster Dose for Targeted Populations (July 7)
- Medi-Cal Rx Training Catalog (July 5)
- Medi-Cal Rx Weekly Wrap-up for June 24-30 (July 1)
- Medi-Cal Rx Monthly Bulletin for July (July 1)
- Changes to the Contract Drugs List (CDL) (July 1)
- Changes to the Contract Drugs List (CDL) – Authorized Drug Manufacturer Labeler Codes (July 1)
- Updates to the Medi-Cal Rx Provider Manual (July 1)
- 30-Day Reminder: Electronic Claims Agreement – Submission Deadline Extended to July 31, 2022 (June 30)
- Medi-Cal Rx Office Hour – Reinstatement of Reject Codes 80 and 88 (June 29)
- Reminder: Fiscal Year Two-week Fee-for-Service Hold for Specific Provider Payments (June 29)
- Now Available: Medi-Cal Rx Telecommunications Provider and Biller Application/Agreement Form – Supplemental Form (June 27)
- Enteral Nutrition Updates Additions, Effective July 1, 2022 (June 24)
- Medi-Cal Rx Weekly Wrap-up for June 17-23 (June 24)
- Medi-Cal Rx Point-of-Sale Messaging Update (June 22)
- Appendix A: Reject Code 88 DUR: Service Codes Scenarios (June 22)
- NDPDP Reject Code 88 DUR Reference Guide (June 22)
- NCPDP Reject Code 80 Reference Guide (June 22)
- 30-Day Countdown – Reinstatement of Reject Codes 80 and 88 (June 22)
- Medi-Cal Rx Weekly Wrap-up for June 10-16 (June 17)
Finally in California, the Department of Health Care Services posted the “August 2022 Medi-Cal Provider Training Webinars”.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
Both Houses of the legislature passed SB 399 that authorizes a pharmacist to order, test, screen, and treat certain health conditions pursuant to a statewide written protocol for CLIA waived tests approved by the Division of Public Health. This legislation is pending Governor Carney’s (D) signature.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Florida
Governor Ron DeSantis (R) issued an Executive Order to address the cost of prescription drugs in the state. The order directs all executive agencies to include provisions in all future contracts and solicitations with PBMs (Pharmacy Benefits Managers) (Pharmacy Benefit Manager), services that include the following:
- Prohibit spread pricing for all PBMs
- Prohibit reimbursement claw backs for all PBMs
- Directs agencies to include reporting requirements and data transparency, including a review of all rebates, payments, and relationships between pharmacies, insurers, and manufacturers
- Directs all impacted agencies to amend all contracts with these same provisions.
Also in Florida, 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).
In accordance with CMS requirements, all Fee-For-Service claims submitted October 1, 2022, or after from a non-exempt provider type that do 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.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Iowa Medicaid Enterprise (IME) released the final July 2022 Cost of Dispensing (COD) Report with the following results:
- The report reflects the mean cost of dispensing, weighted by Medicaid volume, was $10.97 per prescription for all pharmacies, including specialty pharmacies.
- For non-specialty pharmacies only, the mean cost of dispensing, weighted by Medicaid volume, was $10.18 per prescription.
IME stated the current dispensing fee of $10.38 will remain in place until additional state funding is appropriated by the Legislature next session to increase the dispensing fee to $10.97. A state plan amendment (SPA) would also be required, if funding is approved, and the increase would be prospective following CMS approval of the SPA.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Massachusetts
The Massachusetts House of Representatives passed HB 4930 “Relative to Expanding Access to Reproductive Rights” by a vote of 136 – 17. This bill will now be considered by the State Senate. This legislation provides legal protections for Massachusetts health care providers, including pharmacists, from prosecution by out-of-state jurisdictions for legally protected health care and reproductive health care services and products provided in Massachusetts to out-of-state residents. This language is designed to protect these providers from criminal prosecution and associated civil lawsuits from states that prohibit access to legal health care and reproductive health services and products.
Also in Massachusetts, the Commonwealth’s Senate today unanimously passed SB 2955 which will allow pharmacists to prescribe, dispense and administer HIV prevention drugs. This bill now goes to the House for their consideration.
Finally in Massachusetts, the Board of Pharmacy has announced that additional guidance will be provided now that the FDA (Food and Drug Administration) (Food and Drug Administration) has updated the emergency use authorization (EUA) for Paxlovid™ to permit prescribing by pharmacists, subject to the terms of that EUA. Any prescribing must comply with the Emergency Use Authorization (EUA) and DPH’s prescribing guidance.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Mississippi
The Mississippi Division of Medicaid (DOM), on July 1, 2022, will reestablish payment methods for the ingredient costs of prescription drugs that existed prior to the July 1, 2021 rate freeze. This change will remove the freeze for dates of service on or after July 1, 2022. DOM has been in frequent communication with the Centers for Medicare and Medicaid Services (CMS) regarding State Plan Amendment 21-0018, which was submitted last year to freeze reimbursement for outpatient drugs in compliance with Senate Bill 2799 as passed during the 2021 Legislative Session. While CMS has not yet taken official action, DOM anticipates CMS will disapprove SPA 21-0018. Once this disapproval is received from CMS, DOM will reprocess fee-for-service claims for prescription drugs with dates of service between July 1, 2021, and June 30, 2022.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Nebraska
The Department of Health and Human Services (DHHS) announced the new fee schedule for injectables effective July 1, 2022.
Also in Nebraska, the DHHS issued a notice of public hearing on August 8 for proposed changes to Title 471, Chapter 7 of the Nebraska Administrative Code (NAC) – Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS).
Also in Nebraska, the DHHS posted the July 12 DUR (Drug Utilization Review) Board Meeting Agenda and the May 10 Draft Minutes.
Also in Nebraska, the DHHS published Provider Bulletin 22-12: Changes to Nebraska Medicaid Preferred Drug List (PDL) effective July 22.
Finally in Nebraska, the DHHS posted the following:
- Medicaid’s next COVID update call will be held on Wednesday, August 3 at noon (Central). Call details will be added at this website one week before the call.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Hampshire
Governor Sununu (R) signed NH SB 229 into law, expanding the authority of qualified pharmacy technicians to immunize. A pharmacist, pharmacy intern, [or] licensed advanced pharmacy technician, or certified pharmacy technician, under the supervision of an on-site immunizing pharmacist may administer influenza and a COVID-19 vaccine, if available, to the public. A pharmacist, pharmacy intern, or licensed advanced pharmacy technician, under the supervision of an on-site pharmacist may administer Hemophilus influenza, hepatitis A, hepatitis B, hepatitis A and B, human papillomavirus, meningococcal, pneumococcal, tetanus, and diphtheria, varicella, zoster, MMR (measles, mumps, and rubella), and Tdap (tetanus, diphtheria, and pertussis) vaccines, which have been approved by the Food and Drug Administration, to individuals 18 years of age or older as ordered by an immunizing pharmacist. This law goes into effect 90 days after July 27.
Also in New Hampshire, Governor Sununu (R) vetoed NH HB (House Bill) 1022 which would have permitted Ivermectin to be dispensed via standing order.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.