Nevada
The Board of Pharmacy is holding a public hearing on July 18 in Reno. The full meeting agenda has not been posted.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Ohio
Ohio will soon join the ranks of states that have updated its immunization law post-pandemic. On June 26, the last day of session prior to summer recess, the House passed, and the Senate concurred on SB 144. The bill will permit pharmacists and technicians to administer a vaccine “for any disease” to patients aged five years and older. It is now on its way to Gov. Mike DeWine (R) for signing. NACDS thanks our in-state partners, members and allies for the remarkable team effort in getting this bill across the finish line.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Effective July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) will implement a single, state-directed pharmacy benefit preferred drug list (PDL) for all members and providers enrolled in the South Carolina Healthy Connections Medicaid program; see MB #24-016 for details.
SCDHHS recently held live training webinars to answer questions from providers about the upcoming transition to a single PDL. The training sessions were intended for prescribers and dispensers. A recording is available on SCDHHS’ website for those who were unable to attend either training webinar. A frequently asked questions document, which is available in the pharmacy section of SCDHHS’ website, has also been updated.
The single PDL is based on SCDHHS’ current fee-for-service (FFS) PDL. The current FFS PDL is available in the pharmacy section of SCDHHS’ website.
As a reminder, South Carolina’s Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in MB #24-016 for Healthy Connections Medicaid members who are enrolled in an MCO.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The TennCare pharmacy diaper program will launch on August 1, 2024. For children ages two years and younger, the program provides access to up to 100 diapers per month per child. Children with TennCare or CoverKids are eligible. Pharmacies can voluntarily participate as access points for the program; an informational webinar for pharmacies will be held on July 9 from 9:00-10:00 am CT.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) will update the Medicaid Preferred Drug List (PDL) on July 25. HHSC is making changes to the PDL based on recommendations agreed to at the January and April Drug Utilization Review (DUR) Board meetings. The April 26, Preferred Drug List recommendations and January 26 Preferred Drug List decisions are available for review.
Also in Texas, in advance of the July 1, 2024 deadline, NACDS submitted comments to the HHSC VDP in support of the draft policy change expanding the list of vaccines included on the Medicaid formulary. Importantly, adopting this updated policy would expand access to a broader portfolio of pharmacy provided vaccines for adults covered under the Medicaid program. NACDS also urged VDP to adjust the Medicaid pharmacy vaccine administration fee to align more closely with the administration fee that CMS has set for pharmacy-provided vaccines covered by Medicare.
Finally in Texas, the Prescription Monitoring Program (PMP) Advisory Committee met on June 27. The PMP Advisory Committee recommends to the Board of Pharmacy operational improvements, identifies data concerns and suggests methods to improve data accuracy, integrity and security.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Committee (PQAC) held a one-day meeting on June 27.
Also in Washington, starting in July, Apple Health coverage is expanding to adults age 19 years and older with certain immigration status.
Finally in Washington, the Health Care Authority (HCA) published quarterly updates to many of the Apple Health billing guides that go into effect on July 1, 2024. Billing guides are located on HCA’s Provider billing guides and fee schedules webpage.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Servies posted the following alerts and weekly notice on the Medi-Cal Rx Web Portal.
- Mass Adjustment for Enteral Nutrition for Impacted Claims Submitted December 27, 2022, through March 13, 2023
- Mass Adjustment for Blood Factors for Impacted Claims Submitted January 1, 2022, through October 25, 2022
- Mass Adjustment for Diabetic Lancets for Impacted Claims with a Date of Service January 1, 2022, through December 31, 2022
- Mass Adjustment for Disposable Insulin Delivery Devices for Impacted Claims Submitted April 1, 2022, through April 28, 2022
- Code I Diagnosis Requirement for Chronic Weight Management
- Medi-Cal Rx Weekly Wrap-up for June 7-13
Also in California, the Department of Health Care Services posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
The Family and Social Services Administration’s (FSSA) Health Coverage Programs (IHCP) issued BT202476 to update providers on Health Indiana Plan (HIP) preventive care services exempt from copayment.
Also in Indiana, the Health Coverage Programs (IHCP) issued a bulletin reminding providers about the Fee-for-Service (FFS) prior authorization appeals process.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
The Board of Pharmacy is meeting at 8:30 am on July 11 in Topeka via Teams; view the meeting’s webpage for a list of proposed rules and instructions on how to join the meeting in Teams. At 1:00 pm, the Board will be discussing the new proposed telepharmacy regulations.
Also in Kansas, Gov. Laura Kelly (D) convened a special session on June 18 to address taxes. The session was necessary because she vetoed the legislature’s tax bill.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
Gov. Jeff Landy (R) signed into law SB 281 – ACT 514, legislation pharmacies supported that will enhance the Attorney General’s enforcement authority over PBM audits, effective August 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
NACDS will be joining the Massachusetts Chain Pharmacy Council and other members of the Patients Not PBMs coalition in support of PBM reform legislation at the Massachusetts State House on Wednesday, June 26, 2024, at 11:00am. The event will include speakers from the pharmacy and patient communities. NACDS encourages members to send as many pharmacists and associates as possible.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Michigan
Medicaid Bulletin MMP 24-19 was issued on May 31 to announce updates to the Medicaid Provider Manual.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Department of Social Services MO HealthNet (Medicaid) Pharmacy Preferred Drug List (PDL) and Utilization Management Edits updates are available online.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Department of Health issued protocols to increase access at pharmacies for Medicaid patients to over-the-counter (OTC) emergency contraception, the OTC progestin-only birth control pill and the OTC home pregnancy tests.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
On July 1, 2024, Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans (or “Tailored Plans”) are a new kind of Medicaid Managed Care health plan. Tailored Plans cover doctor visits, prescription drugs and services for mental health, substance use, intellectual/developmental disabilities and traumatic brain injury in one plan. Tailored plans will launch statewide starting July 1, 2024. Approximately 200,000 beneficiaries will be enrolled into Tailored Plans. For more detailed information, please review the Fact Sheet: What Providers Need to Know Before Tailored Plan Launch.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The House Health Committee advanced SB 144, a priority bill for members. The legislation will more closely align the existing pharmacy immunization law with the PREP Act. Specifically, the bill permits pharmacists, interns and technicians to administer any vaccine to patients aged 5 years and older. We expect the House and the Senate to give final approval to the bill next week. If all goes as planned, it should be on the Governor’s desk before summer recess. The bill will be effective 90 days after it is signed.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
A coalition of pharmacy groups, including American Pharmacies, Inc., the American Pharmacists Association, the National Community Pharmacists Association, the Oklahoma Pharmacists Association and NACDS, asked the U.S. Supreme Court to once again decide whether states can regulate pharmacy benefit managers after the Tenth Circuit Court of Appeals struck down a lower court that upheld a law passed by Oklahoma in 2019.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
NACDS submitted a letter to the Prescription Drug Affordability Board (PDAB) expressing concern about the inclusion of vaccines in PDAB affordability reviews and strongly encouraging the removal of vaccines as eligible for affordability reviews by the PDAB. Both the Affordable Care Act and the Inflation Reduction Act mandate that all vaccines recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) are covered without cost-sharing for all publicly and privately insured individuals.
Also in Oregon, the Prescription Drug Affordability Board (PDAB) posted the agenda and meeting materials for its next meeting on June 26. Please register in advance of the meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
The Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments in June-July 2024. Due to the Independence Day holiday, June 28 is the deadline to submit claims for payment date July 5. Payments will run July 1 and electronic remittance advice will be available on July 4. Payments will be dated July 5, as usual. The schedule will return to the normal payment cycle on payment date July 5, 2024. Please refer any questions or concerns regarding this bulletin to the Provider Service Center (PSC) at (888) 289-0709.
Also in South Carolina, effective July 1, 2024, the Department of Health and Human Services (SCDHHS) is updating and clarifying policies in the Provider Administrative and Billing Manual. These policy changes will be added to the Provider Administrative and Billing Manual available on SCDHHS’ website by July 1.
Finally in South Carolina, the Centers for Medicare and Medicaid Services (CMS) has informed the Department of Health and Human Services (SCDHHS) that Healthy Connections Medicaid providers will participate in the Payment Error Rate Measurement (PERM) program for state fiscal year 2025; see MD #24-029 for details. CMS’ PERM program was developed to measure the accuracy of Medicaid and Children’s Health Insurance Program (CHIP) payments made by states. Each state is reviewed once every three years. Samples of claims with paid dates of July 1, 2024, through June 30, 2025, will be subject to review.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP) Medicaid is soliciting stakeholder comments about adding 14 additional vaccines to be a covered benefit for the Adult Vaccines Program. HHSC already covers influenza and COVID-19 vaccines on the Texas Medicaid formulary and proposes adding the additional vaccines listed above for adults ages 19 years and older enrolled in Medicaid. Comments are due on July 1, 2024, and must be submitted using the HHS Form 1342.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Board of Pharmacy posted the agenda for its June 25 meeting. Please note they intend to discuss the emergency regulations for central fill/remote processing, the final regulations updating the 2022 test and treat law and current pharmacy workforce conditions in preparation for a new workforce survey.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The Pharmacy Quality Assurance Commission (PQAC) is meeting on June 27. Written comments must be submitted by 5:00 pm on June 21 to WSPQAC@doh.wa.gov.
Also in Washington, the Health Care Authority’s (HCA) Health Care Cost Transparency Board began collecting data from the largest health insurance carriers in the state in 2022. The first annual report, Health care spending growth in Washington, 2017–2019, and one-page summary of key findings are now available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
The Board of Pharmacy proposed regulation changes dealing with pharmacy technicians, collaborative practice authorities, sterile pharmaceutical guidelines, manufacturer license requirements, PDMP (Prescription Drug Monitoring Program) registration, alternative to probation program and definitions. Written comments should be submitted to RegulationsAndPublicComment@alaska.gov by 4:30 pm on July 8.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
The Legislative Council approved a rule that allows Medicaid reimbursement for continuous blood glucose monitors (CGMs).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Servies posted the following alerts, weekly report and monthly bulletin on the Medi-Cal Rx Web Portal.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.