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.
On June 1, Legislative Leaders announced a 2022-2023 Joint Budget Agreement that contains budget priorities from the Assembly and the Senate as well as elements of the Governor’s budget proposals. The agreement provides an overall plan to provide relief to families and small businesses, including $142.8 million over two years designated to forgive recoupment of pharmacy reimbursement rate reductions in Medi-Cal from prior years for independent pharmacies. NACDS and the California Retailers Association (CRA) have been advocating in recent months for forgiveness of the Medi-Cal Recoupments for all pharmacy providers. On June 3, NACDS and CRA submitted a joint letter to Gov. Gavin Newsom (D) urging him to allocate the $142.8 million for Medi-Cal pharmacy rate recoupment to all applicable pharmacies, including chains.
Also in California, the Department of Health Care Services posted the following alerts and notices on the Medi-Cal Rx Web Portal.
Finally in California, the Board of Pharmacy has posted the following documents for its Full Board Meeting to be held on June 16.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Maine Board of Pharmacy has released its minutes from April and May meetings. The next Board meeting will be on August 4.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Massachusetts Board of Pharmacy has updated its Policy 2022-03 which deals with unfilled Prescriptions. The Board decided to update the policy based on information from the DEA to allow pharmacies to send unfilled electronic prescriptions for federally controlled substances, including CII, to another pharmacy for initial fill. This can be done either by verbal transfer or election transmission, but methods must be pharmacist-to-pharmacist and follow the transfer requirements of 21 CFR section 1306.25. The next Board of Pharmacy meeting is scheduled for August 4.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.