The Department of Health and Human Services issued a final bulletin related to the end of COVID flexibilities for OTC (Over-the-Counter) COVID tests and pharmacies as labs.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Effective September 6, 2024, brand name Adderall XR® will no longer be preferred on the MO HealthNet Preferred Drug List (PDL). Dextroamphetamine/Amphetamine ER capsules (generic Adderall XR®) is currently a preferred agent on the PDL and will continue to remain a preferred agent. Please reference the List of Preferred & Non-Preferred Products, as well as the ADHD, Amphetamines Long Acting PDL edit for more information. Maximum Allowable Cost (MAC) rates will apply to brand and generic products. Providers who dispense the brand product without a prior authorization (based on medical necessity) will receive MAC reimbursement.
Also in Missouri, on August 29, the Medicaid Audit & Compliance (MMAC) launched the new secure Provider Communications Portal, which is an efficient method for providers and MMAC to communicate and exchange information and records.
Finally in Missouri, effective August 29, MO HealthNet expanded coverage of Continuous Glucose Monitors (CGMs) to participants currently diagnosed with Gestational Diabetes allowing this vulnerable population to obtain a CGM without prior authorization. Claims for a CGM will auto-approve if the participant has had a gestational diabetes diagnosis billed to MO HealthNet recently or if the pharmacy submits the appropriate gestational diabetes diagnosis code with the claim. Any MO HealthNet participant who currently utilizes insulin can also obtain a CGM without prior authorization.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Board of Pharmacy posted the agenda (revised August 29, 2024) for its September 9 meeting.
Also in Nebraska, new income guidelines increased the number of families who could qualify for the Women, Infants and Children (WIC) supplemental nutrition assistance program. The WIC program is a federally funded program and is an equal opportunity provider. The maximum income allowed for participation in WIC increased. Some families not eligible for the program in the past may now be eligible. Nebraska WIC serves every county in the state with 13 main agencies and over 100 sites.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Medicaid is committed to supporting increased adoption and utilization of the Board of Pharmacy statewide protocols authorized by legislation. As part of this commitment, effective August 1, 2024, immunizing pharmacists began to receive reimbursement for clinical services provided when utilizing the statewide Nicotine Replacement Therapy (NRT) Protocol. This bulletin applies to Medicaid Managed Care and Medicaid Direct. The claim should be submitted using a medical claim and payment will be issued to the pharmacy.
Also in North Carolina, effective September 1, 2024, Medicaid began covering condoms and spermicides as over-the-counter products, through the pharmacy benefit. This coverage applies to both Medicaid Direct and Managed Medicaid Plans. Coverage supports reproductive health care for Medicaid beneficiaries, including prevention of unintended pregnancy and sexually transmitted diseases. Medicaid beneficiaries will be able to obtain condoms and spermicides from pharmacies enrolled in Medicaid with a prescription from a Medicaid-enrolled provider, with no cost sharing responsibility.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Board of Pharmacy issued draft rules to implement SB 144, the new pharmacy immunization expansion law that passed in July. We have reviewed the rule and found no issues or concerns and intend to file a letter of support. However, if members have any concerns or comments, please share them with Jill McCormack by September 13.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Prescription Drug Affordability Board (PDAB) posted the draft agenda for its next meeting on September 18. Please note the “Medicare MFP modeling presentation and SB 192 upper payment limit discussion” by PDAB staff and Myers and Stauffer on the draft agenda. You must register in advance of the meeting to participate.
Also in Oregon, NACDS, as a participant in the PBM Working Group, submitted a letter to Rep. Rob Nosse (D), Chair, House Behavioral Health and Health Care Committee, to provide comments and pharmacy reimbursement concepts in advance of the next working group meeting scheduled to be held on September 18.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
During the most recent Board of Pharmacy meeting, the Board confirmed that rules for technician immunizations will not be finalized before the PREP Act expires. However, technicians should still be able to vaccinate after receiving a waiver from the Board’s Executive Director Lucy Shell. NACDS and Tennessee Pharmacy Association are working to confirm details of this process and will share more information as it becomes available.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
The Health and Human Services Commission (HHSC) implemented a new STAR+PLUS contract in seven managed care organizations (MCOs) on September 1, 2024. Pharmacy claims billing codes and contact information for these MCOs are available.
Also in Texas, HHSC’s Vendor Drug Program (VDP) revised the Pharmacy Payer Specification Manual, separating them by program. The three separate manuals are the Traditional Medicaid and the Healthy Texas Women Program, the Children with Special Health Care Needs Services Program and the Kidney Health Care Program. The three new manuals are available on the VDP Provider Portal.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Department of Medical Assistance Services (DMAS) held an initial virtual meeting with pharmacy associations to discuss the upcoming pharmacy cost-of-dispensing survey (slide deck). The survey instrument has not been finalized; however, Myers & Stauffer intends to send it to pharmacies on September 12. Additional informational webinars for all pharmacy stakeholders are tentatively scheduled for September 24 and September 26.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.