California

Medi-Cal Rx posted the following alerts. To view all alerts, visit Bulletins & News on the Medi-Cal Rx website. 

Also in California, note the recently issued Billing Guidance for Pharmacy Providers on COVID-19 Oral Antivirals (January 6). 

Also in California, the Board of Pharmacy issued a pharmacy law waiver for Prescriber Dispensing of COVID-19 Oral Therapeutic Medication to Emergency Room Patients.  

Finally in California, the Board of Pharmacy has rescheduled its next quarterly two-day meeting.  The new meeting dates are January 27-28.   Committee meeting materials have also been posted. 

  • January 18, 2022 
  • January 19, 2022 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2022-01-14T14:53:35-05:00January 14, 2022|California|

Colorado

The Department of Health Care Policy and Finance (HCPF) announced today that they received approval from CMS to further increase the Health First Colorado and CHP+ reimbursement rate for COVID-19 vaccine administration to $61.77 for the first two doses, retroactive to September 1, 2021. This rate is triple the typical Medicaid vaccine administration rate and 50% above the Medicare rate.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2022-01-14T14:51:20-05:00January 14, 2022|Colorado|

Delaware

The Delaware Board of Pharmacy has proposed revisions to its rules and regulations. All comments are due by February 3, 2022. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2022-01-14T14:50:32-05:00January 14, 2022|Delaware|

Illinois

The Illinois Department of Healthcare and Family Services has posted a new Provider Notice regarding Pharmacy Instructions for COVID-19 Vaccine for Children Ages 5-11. You may view the new Notice at the following link as well as a new Provider Notice regarding Pharmacy Billing of Subcutaneous Monoclonal Antibody Treatment. You may view that new Notice at the following link.  

Also in Illinois, the Illinois Department of Healthcare and Family Services has posted an Updated DME Fee Schedule. Please note: Corrections have been made to codes L0637, A4230 and A4231. You may view the new Fee Schedule at the following link. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2022-01-14T14:49:47-05:00January 14, 2022|Illinois|

Kentucky

Rep. Steve Sheldon (R) has introduced legislation to comprehensively regulate Pharmacy Benefit Managers. House Bill 203 would regulate PBMs in commercial and self-insured plans, as well as the state employee plan. The bill includes patient choice of pharmacy protections and measures that protect pharmacy reimbursed. It would also prohibit mandatory mail order, require any rebates to reduce patients’ out-of-pocket costs and set a pharmacy reimbursement floor based on NADAC + professional dispensing fee. Additionally, it would require PBMs to treat 340B claims like other prescription claims for reimbursement purposes. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

2022-01-14T14:48:07-05:00January 14, 2022|Kentucky|

Louisiana

Referencing the federal law and regulations, the Board of Pharmacy’s Regulation Revision Committee sent to the full Board for final consideration at the February 16 meeting draft CLIA guidelines confirming that properly credentialed pharmacies may perform moderately complex lab testing. 

Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing issued a Provider Update on reimbursement for COVID-19 booster shots and third doses for Medicaid Fee for Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs). Effective January 18th, Louisiana Medicaid will reimburse enrolled pharmacies for the administration fee or $37.08 or billed charges, and not for the ingredient for COVID-19 vaccines. No dispensing fee shall be reimbursed.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2022-01-14T14:46:17-05:00January 14, 2022|Louisiana|

Maryland

The Maryland Insurance Administration (MIA) has released its report on the impact of Rutledge v. PCMA and the subsequent Webhi decision on Maryland law and the MIA’s ability to regulate Pharmacy Benefits Managers (PBMs) and their relationship with pharmacies in Maryland. The report was mandated by the passage of HB 601 of 2021. It concluded that, should the legislature pass legislation regulating PBMs when providing services to an ERISA plan, ERISA would not preempt the MIA’s enforcement of those laws. The report also provides a summary of previously passed laws related to PBMs in Maryland and MIA’s current methods of enforcing them. The report cites comments from NACDS and the Maryland Association of Chain Drug Stores submitted last fall, which highlighted examples of pro-pharmacy laws that align with the Rutledge decision.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

2022-01-14T14:44:59-05:00January 14, 2022|Maryland|

Missouri

Gov. Parson’s (R) ended the COVID-19 State of Emergency on December 31, 2021, ending all remaining COVID-19 related waivers authorized under EO 21-09. The Board of Pharmacy issued guidance on the expiration of the Emergency Declaration.  

Also in Missouri, the Department of Social Services MO Health Net (Medicaid) clarified reimbursement for COVID-19 antiviral treatment. Pharmacy providers filling prescriptions for Paxlovid or molnupiravir will be reimbursed the current professional dispensing fee at the time the prescription is dispensed. For pharmacies to receive the full dispensing fee, the Usual & Customary charge submitted to MO HealthNet must be more than the current professional dispensing fee. Non-pharmacy providers such as clinics, hospitals, and ERs do not receive a professional dispensing fee. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2022-01-14T14:43:49-05:00January 14, 2022|Missouri|

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