Iowa
The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2585-MC-FFS Avastin® (bevacizumab) Billing.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
Effective June 1, 2024, the Department for Medicaid Services made changes to the vaccine coverage for Medicaid Fee-for-Service members.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The legislature adjourned sine die on June 3.
Also in Louisiana, several bills’ pharmacies supported passed both houses and were sent to Gov. Jeff Landry (R) to be signed into law.
HB 579 – Allows pharmacists to test and treat for PEP/PrEP (See NACDS’ letter to the governor supporting enactment of this legislation.)
SB 444 – Prohibits reimbursement below cost
HB 603 – PBM audits
SB 281 – PBM Enforcement and audits
Finally in Louisiana, the Department of Health issued the preferred drug list update for July 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The Prescription Drug Affordability Board (PDAB) announced the June virtual meeting of its Stakeholder Council, scheduled for 2:00 pm on June 24. The agenda and other meeting materials will be available on the Stakeholder Council page of the PDAB’s website prior to the scheduled meeting. To register for the June 24 virtual meeting, please click on this link and enter the required information. After registering, you will receive a confirmation email containing details about joining the meeting. Also, to register for oral public comment and for additional information concerning public comments, please refer to the Stakeholder Council page.
Also in Maryland, please visit the Prescription Drug Affordability Board’s, Cost Review Study Process page on the Board’s website to learn more about the comment period for “Board Selected Drugs for Cost Review.” The 60-day comment period will close on July 22, 2024.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
MassHealth published its June “All Provider Bulletin 391” with orders ALL 361, ALL 376 and ALL 380 announcing the start dates for enforcing the ordering, referring and prescribing (ORP) requirements. With the exception of the information in the bulletin, all information in ALL 361, ALL 376 and ALL 380 remains in effect. Opportunity for payment of claims initially denied due to unenrolled ORP provider as described in ALL 376, billing providers should take certain steps to avoid claim denials due to unenrolled ORP providers. If a claim is denied because of an unenrolled or unauthorized ORP provider on or after June 9, 2024, the claim will be placed in suspense status. The claims system will continue to check to see if the ORP provider has enrolled with MassHealth for up to 90 days after the first date of service on the claim. Once the ORP provider is enrolled, the claim will then be payable. This will allow billing providers time to follow the steps related to unenrolled ORP providers outlined in ALL 376. If the ORP provider is not enrolled by 90 days from the first date of service on the claim, the claim will be denied. Also, effective June 9, 2024, billing providers can resubmit claims that were previously denied due to an unenrolled or unauthorized ORP provider if the first date of service on the claim is no earlier than September 1, 2023. If the ORP provider is enrolled with MassHealth within 90 days of the first date of service on the claim, the claim will be payable.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Michigan
Pharmacy Controlled Substance Administrative Rules have been revised and changes are effective as of May 31, 2024. One amendment of note is the removal of Gabapentin, meaning it is no longer classified as a controlled substance in the state. A prescriber without a controlled substance license can now prescribe Gabapentin, and Gabapentin no longer needs to be included in reporting to the Michigan Automated Prescription System (MAPS).
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Department of Social Services, MO HealthNet Division (MHD), reminded covered entities to comply with all the Health Resources and Services Administration (HRSA) 340B Program rules, including the exclusion of using 340B stock for inpatient administration and the prohibition of duplicate discounts.
Also in Missouri, to raise awareness about Project Hep Cure, Josh Moore, the Director of Pharmacy at MO HealthNet, sent a message to healthcare providers on how to help cure Missourians of the disease.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oklahoma
The legislature adjourned sine die on May 30.
SB 232, legislation allowing pharmacists to screen and treat for minor ailments and other conditions, dispense hormonal contraceptives without a prescription and increase the pharmacy technician ratio from two to three, died due to the early adjournment of the legislature.
Two PBM reform bills that pharmacies supported because they enhanced the Attorney General’s enforcement authority, addressed MAC pricing and audits, were enacted into law. SB 1670 / HB 3376
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy will meet on June 12-14. The agenda and meeting materials are available online.
Also in Oregon, the following individuals have been appointed to the Board of Pharmacy: Amy Kirkbride with Kaiser Permanente, Victoria Kroeger with Walgreens and Ana Pinedo.
Finally in Oregon, the Division of Financial Regulation announced this proposed rulemaking. These proposed rules implement 2023 Oregon Enrolled SB 797, Oregon Laws 2023, chapter 113, which requires certain health insurance policies to provide coverage for prosthetic and orthotic devise as defined in the bill.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please see the June 2024 Provider Update from Medicaid. All previous provider updates are available online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming June-August 2024 training is listed below.
Medicaid eLearning Provider Workshops
SCDHHS’ contracted vendor provides web-based training, presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.
To register for a workshop or find additional training resources, please visit www.medicaidelearning.com or call the Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday.
Also in South Carolina, with the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) is required to resume the provider revalidation process. SCDHHS will restart this process in June 2024.
In order to revalidate or renew the provider enrollment record with the state Medicaid agency, an enrollment revalidation application must be submitted. The provider revalidation process is designed to confirm or update a provider’s demographic and other information including National Provider Identifier, mailing address and service location address(es). There are no exemptions from revalidation.
Consistent with federal regulations (42 CFR §455.414), state Medicaid agencies must complete revalidation of enrollment for all providers, regardless of provider type, at least every five years. However, provider types designated by either CMS or SCDHHS as “high-risk” providers are required to revalidate every three years. High-risk providers include durable medical equipment (DME), home health agencies, targeted case management, rehabilitative behavioral health services and licensed independent practitioner rehabilitative services. High-risk providers may also require a physical site visit or fingerprint-based criminal background check (FCBC). For more information on high-risk providers, please review the Provider Enrollment and Screening Requirements FAQs.
Impacted providers will receive an official revalidation notification letter in the mail. The notification contains a unique revalidation number necessary to begin and complete the revalidation process. To avoid risk of termination from the Healthy Connections Medicaid program, providers must complete the revalidation process. The first step in the revalidation process is completing the online enrollment revalidation application within 30 days. Providers will be notified when the cohort window is open for their specific provider type to begin the process. Providers must not attempt to begin the revalidation process until they have received notification.
Provider revalidation for cohort one begins June 17, 2024. The revalidation window for cohort two and future cohorts will be announced in subsequent provider bulletins that will be published approximately 30 days prior to the start of the respective revalidation windows.
A list of providers scheduled for revalidation will be published on the SCDHHS’ website as each cohort’s revalidation period begins.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
This notice is being sent to inform you of changes to the TennCare Pharmacy Program. We encourage you to read this thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) should you have additional questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Prescription Monitoring Program’s (PMP) Advisory Committee will meet via Zoom on June 27.
Also in Texas, the Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP) is hosting a Hepatitis C educational webinar on June 13.
Finally in Texas, the Texas Pharmaceutical Initiative (TPI) Board’s next meeting will be held on June 11 at 10:00 am.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
As the Department of Vermont Health Access (DVHA) has previously reported, Change Healthcare (CHC), which operates Vermont’s Medicaid pharmacy claims system, experienced a significant cybersecurity issue on February 21. The cybersecurity incident impacted enrolled pharmacy providers’ ability to process and submit claims for Medicaid services. In response to the outage, Vermont Medicaid is temporarily increasing the Professional Dispensing Fee for retail pharmacies.
Vermont Medicaid will provide an enhanced Professional Dispensing Fee for prescribed drugs to account for the manual and time-consuming procedures pharmacies had to perform due to the Change Healthcare outage. The Professional Dispensing Fee for pharmacy claims of $11.13 will increase by $3.26 per claim to $14.39, from June 3, 2024, to June 30, 2024. This change will be automatically implemented for pharmacy claims, excluding specialty drug and 340B drug claims. Providers are not required to enroll or apply for the enhanced professional dispensing fee. Standard payment of covered outpatient drugs, including over the counter (OTC) drugs, billed to DVHA on a primary basis and dispensed by an enrolled pharmacy is detailed in the Pharmacy Provider Manual. All manuals and rules are available online.
This change is one of several temporary flexibility and changes being made to support providers impacted by the Change Healthcare cybersecurity incident. Additional information on these changes can be found in Global Commitment Register 24-029 Change Healthcare Outage—Medicaid Response. Please contact the Change Healthcare Pharmacy Help Desk with any questions at 1-844-679-5362.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Washington
The Health Care Authority (HCA) will change to a new pharmacy point-of-sale system on June 8. The system will be off from midnight until 3:30 pm on June 8-9. HCA will notify providers once the new system is running and can adjudicate claims. At 5:00 pm on June 6, pharmacy prior authorization faxes will cease being accepted. HCA will start accepting prior authorization faxes again on June 10. HCA’s ProviderOne Point of Sale (POS) Replacement Project provided an updated payer sheet.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
HB 226D, comprehensive legislation pharmacies supported to ensure patient choice of pharmacy, improve transparency and accountability in pharmacy benefit management and enhance the standards for pharmaceutical care across the state, passed the legislature. The bill is awaiting transmittal to Gov. Mike Dunleavy’s (R) office to be signed into law.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts and weekly report on the Medi-Cal Rx Web Portal.
- Reminder: State Fiscal Year Two-Week Fee-for-Service Hold for Specific Provider Payments
- Medi-Cal Rx Weekly Wrap-up for May 17-23
- Updates to Continuous Glucose Monitoring and Disposable Insulin Delivery Devices Quantity Limits, Effective June 7, 2024
Also in California, on May 28, the article titled “Change Healthcare Cybersecurity Issue Update” was posted to the Medi-Cal News area on the Medi-Cal Provider website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
CO24-209, practice act expansion, passed both houses and was sent to Gov. Jared Polis (D) to sign into law.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2589-MC-FFS-D “Discover IA SAIL: Planning for and Addressing Aging Issues Across the Lifespan”.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
HB 579, the PEP/PrEP bill supported by pharmacies, passed both houses and will soon be sent to Gov. Jeff Landry (R) to be signed into law. The Legislature is scheduled to adjourn by 6:00 pm on June 3.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
On May 23, the Senate passed its version of the Fiscal Year 2025 budget. The budget bill will now advance to a legislative conference to work out differences before the end of the fiscal year, June 30, 2024. The relevant issue to pharmacies is language included in the House, but not in the Senate, that would authorize a registered pharmacist to administer a prescription for testosterone for gender-affirming care and for the treatment and prevention of sexually transmitted infections including the prevention of HIV infections. The administration of these therapies shall be in accordance with regulations promulgated by the Department of Public Health in consultation with the Board of Pharmacy and the Department of Mental Health. This proposed change amends the current law which authorizes pharmacists to administer drugs for the treatment of mental health and substance abuse disorders. NACDS will continue to monitor the budget process.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
Mississippi
On July 1, the Division of Medicaid (DOM) will implement a single Pharmacy Benefit Administrator (PBA) to streamline and enhance the processing and management of pharmacy claims for all Medicaid members, including those enrolled in MississippiCAN. Operated by Gainwell Technologies, the PBA will also assume all pharmacy prior authorization responsibilities for drugs submitted on pharmacy claims. DOM will continue to require the use of the Universal Preferred Drug List (PDL). This decision comes after careful consideration and evaluation of various factors aimed at enhancing efficiency and transparency in the Medicaid delivery system. Medicaid members should notice no disruption in their care if providers are prepared for this change.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Montana
On June 17, the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider proposed amendments to Medicaid and non-Medicaid provider rates, fee schedules and effective dates. For pharmacy providers, the following are proposed changes to outpatient drugs reimbursement for both dispensing fees and vaccine administration fees.
(f) The outpatient drugs reimbursement dispensing fees range as provided in ARM 37.86.1105(3)(b) is effective July 1, 2023 July 1, 2024:
(i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $5.11 $5.28, and the maximum is $16.36 $17.01;
(ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $5.11 $5.28, and the maximum is $14.16 $14.73; or
(iii) for pharmacies with prescription volume greater than or equal to 70,000, the minimum is $5.11 $5.28, and the maximum is $11.98 $12.46.
(g) remains the same.
(h) The outpatient drugs reimbursement vaccine administration fee, as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $18.65 $15.53 for each additional vaccine administered on the same date of service, effective July 1, 2023 July 1, 2024.
Concerned persons may submit their data, views or arguments either orally or in writing at the hearing. Written data, views or arguments may also be submitted to: Bailey Yuhas, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail hhsadminrules@mt.gov, and must be received no later than 5:00 pm on June 21.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Board of Pharmacy held a Workshop meeting this week on proposed draft rules establishing minimum staffing requirements. The Retail Association of Nevada (RAN) and our chain members’ comments emphasized that pharmacies should be able to determine the optimal number of pharmacists and technicians to use in their practice setting. We shared data that the number of prescriptions continues to grow coupled with the continued pharmacist shortage and that the Board should focus on solutions that enhance patient access to pharmacies by adopting rules expanding use of pharmacy technicians and technology. After hearing the testimony, the Board voted in favor of pursuing rulemaking.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the Medicaid Pharmacy Benefit Program, announced updates to the Preferred Drug List. These changes were effective May 29.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.