The Office of Medical Assistance Programs (OMAP) has issued a Bulletin with updates to the Statewide Preferred Drug List clarifying when an MCO can require prior authorization for certain drugs. The PACE Prescription Drug Program has also issued a Bulletin clarifying the claims submission code for “other coverage” claims. The Bulletin applies to all prescription programs administered by PACE.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Department of Health and Environmental Control released a statement earlier today regarding the Omicron variant of COVID-19. DHEC is closely monitoring the variant and proactively preparing for any potential threats posed. See their full statement here, along with various resources and tracking data.
Also in South Carolina, the Centers for Medicare, and Medicaid Services (CMS) has announced the enrollment application fee amount for calendar year 2022 will be $631. This fee is required with any applicable Healthy Connections Medicaid provider enrollment application. The South Carolina Department of Health and Human Services (SCDHHS) will collect the application fee before executing a provider agreement. The fee applies to initial enrollment, reactivation, revalidation, or addition of a new practice location. SCDHHS has contracted with the SC.gov Enterprise Payment System to facilitate collection of the application fee. Payments may be made by debit, credit, or e-check. Paper checks will not be accepted. More information on payment options can be found by visiting www.scdhhs.gov/provider and selecting “Online Application Fee Payment.” The provider enrollment application fee is only applicable to providers CMS has identified as institutional providers. Providers who are enrolled in or have already paid the application fee to Medicare and/or another state’s Medicaid agency or Children’s Health Insurance Program (CHIP) for the same enrollment location jurisdiction.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Applications for TPA executive officers, society leaders, and committee members are being accepted through Dec. 15. Volunteer or nominate a colleague to serve.
Also in Tennessee, the Tennessee Department of Health (TDH) is required by the Centers for Disease Control and Prevention (CDC) to audit providers of COVID-19 vaccines. The Tennessee Pharmacists Association requested a checklist for those who have been selected for an audit, and one was prepared by TDH. Please review the checklist and the Routine and Emergency Vaccine Management Plan in their entirety.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy proposed and adopted several rules at their November meeting.
Also in Texas, the Health and Human Services Commission (HHSC) revised the Medicaid preferred drug list effective December 3, 2021.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The State Department of Health’s (DOH) December 7th COVID-19 partner call the Health Care Authority and the Office of the Insurance Commissioner will present information on reimbursement for patient counseling on COVID-19 vaccines, and provider billing and reimbursement for COVID-19 vaccines.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Legislative Rule Making Committee will be considering the PBM rule as approved by the agency on December 8. You can link to the agenda here. NACDS is currently analyzing the rule and will follow up with members operating in the state via email. In the meantime, please share any concerns you may have with the rule with Jill McCormack as soon as possible.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Division of Medical Services is holding a virtual rulemaking hearing on October 20th to consider proposed rules to allow six refills per month, add certain medications that do not count toward the monthly prescription cap, and allow up to nine medically necessary prescriptions per month for Living Choices Assisted Living Program clients. The rule also would specify that clients must pay for their own medications beyond the maximum benefit, remove the extension of benefits provisions, and revise refill requirements.
Also in Arkansas, Gov. Asa Hutchinson (R) announced on November 15th that individuals over 18 are eligible for the booster shot.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The following documents were recently posted on the Medi-Cal Rx Web Portal:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
On October 31st, Gov. Jared Polis (D) issued an Executive Order directing vaccine providers such as retail pharmacies, including those that operate under the fed retail pharmacy vaccine program, to drop existing CDC parameters around boosts eligibility, allowing all access to booster shots.
For more information, contact NACDS’ Mary Staples at 817-442-1155.