Ohio

The Board of Pharmacy has posted the following updates:

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

2024-06-13T14:38:44-04:00June 13, 2024|Ohio|

Oklahoma

The Health Care Authority (OHCA) provided public notice of a proposed change in methods and standards for setting payment rates for services in the SoonerCare (Medicaid) program. Contingent upon CMS’ approval, effective July 1, 2024, the OHCA will reimburse pharmacists at a rate equal to other providers when providing services within their scope of practice. Vaccine administration is the only claimable service determined to be within the scope of practice of pharmacists at this time. The state plan amendment (SPA) establishes that services provided by pharmacists will be reimbursed in accordance with the reimbursement methodology currently established for physician services.

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

2024-06-13T14:37:50-04:00June 13, 2024|Oklahoma|

Pennsylvania

Last week, the House of Representatives’ Children and Youth Committee advanced HB 2037, which would expand pharmacy’s ability to immunize children. The bill would allow pharmacists to administer ACIP vaccines to kids aged 5 years and older and allow pharmacy technicians to immunize children aged 8 years and older for flu and COVID. NACDS has been actively engaged in advocacy on the bill. The bill is now eligible for a vote by the full Senate.

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

2024-06-13T14:37:23-04:00June 13, 2024|Pennsylvania|

South Carolina

Effective for dates of service on or after August 1, 2024, the Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the physician-administered drugs in the document linked below to ensure use is consistent with the medication’s indication(s) and appropriate clinical guidelines. This change only applies to medications administered to Healthy Connections Medicaid members enrolled in the fee-for-service (FFS) Medicaid program.

The list of physician-administered drugs for which a PA is required when administered to a FFS Medicaid member is available in the Procedure Codes section of the Physicians Services provider manual on the SCDHHS website. The list in the manual will be updated with the additional physician-administered drugs requiring a PA beginning August 1, 2024. The list of additional drugs is available online.

Requests for PA and questions about this bulletin should be submitted to Magellan Rx Management at https://MRxGateway.com or by calling 1-800-424-8219 between 8:00 am-5:00 pm Monday-Friday.

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

2024-06-13T14:36:22-04:00June 13, 2024|South Carolina|

Tennessee

Prior authorization requirements can be bypassed for certain medications when specific medical conditions exist. The submitted claim should include a Diagnosis Code Qualifier (Field # 492- WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). See the lists of the preferred agents and the clinical criteria and see the list of Tennessee OptumRx Provider Liaisons.

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

2024-06-13T14:35:31-04:00June 13, 2024|Tennessee|

Texas

The Board of Pharmacy (TSBP) adopted and proposed several new rules at the May 7 Board meeting.

Also in Texas, the Pharmaceutical Initiative (TPI) met this week to discuss how to provide greater, more cost-effective access to prescription drugs and essential medical supplies for the health plans for state employees, retirees, Medicaid and CHIP. The three-member Board focused on developing a business plan and hiring an Executive Director.

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

2024-06-13T14:34:46-04:00June 13, 2024|Texas|

Vermont

On June 10, the Department of Vermont Health Access (DVHA) informed pharmacy providers of some important updates in the restoration of pharmacy services that were implemented in the Medicaid system, effective June 8.

  • Drug Pricing Updates:

NADAC (National Average Drug Acquisition Cost), AWP (Average Wholesale Price), FUL (Federal Upper Limit) and SMAC (State Maximum Allowable Drug Cost) drug pricing will be updated to reflect the most accurate and up-to-date pricing information.

  • New Drug Products and NDC (National Drug Code) Updates:

The Medicaid system will be updated to include the latest Medispan drug files which will add new drug products and NDCs that have been missing during the restoration process. This update will enhance Medicaid’s database with comprehensive information regarding the latest medications available.

  • SMAC Disputes:

Medicaid updated its contact information for SMAC disputes. Please note the updated email address below:

  • Rejected Claim Issues:

Pharmacy Providers with claims still requiring assistance from the system outage (February 21, 2024 – March 18, 2024), please contact the Pharmacy Helpdesk at CHC/Optum for assistance.

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

2024-06-13T14:34:09-04:00June 13, 2024|Vermont|

Washington

The Health Care Authority (HCA) is hosting a webinar on June 25 at 11 :00 am Pacific time to educate providers on Apple Health (Medicaid) eligibility, benefits and expansion.

Also in Washington, Apple Health’s new point-of-sale system is live and processing claims. Providers are reminded to update to the new billing information for fee-for-service (FFS) clients:

  • New BIN = 024822
  • New PCN = DRWAPROD
  • New Group = CAID

Also In Washington, Apple Health’s new fax number is 833-991-0704.

Also in Washington, the Chief Science Officer signed an updated standing order that allows pharmacies to dispense the naloxone products to eligible persons and entities.

Also in Washington, HCA (Health Care Authority) published a revised Prescription Drug Program Billing Guide.

Finally in Washington, the Pharmacy Quality Assurance Commission (PQAC) is accepting applications to fill current and upcoming public member and pharmacist member vacancies. To qualify for a public member position, an individual must be a resident of Washington State and not affiliated with any aspect of pharmacy. To qualify for a pharmacist member position, an individual must be a resident of Washington State and, at the time of their appointment, have been a licensed pharmacist in Washington State for at least five consecutive years immediately preceding appointment.

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

2024-06-13T14:30:22-04:00June 13, 2024|Washington|

Alabama

Medicaid will begin to migrate the remaining recipients from the Alabama Medicaid Agency Eligibility System (AMAES) to the newer Centralized Alabama Recipient Eligibility System (CARES) in June 2024. Medicaid anticipates the process will be completed by July 1, 2024.  

Medicaid recipients with a Medicaid ID number starting with 500 will get a new Medicaid ID number that starts with 530 (unless they already have a 530 Medicaid number). New Medicaid cards will be sent to recipients who do not already have a Medicaid card with the new 530 number.  

Recipients in nursing facilities may receive a new Medicaid number but not a card. Medicaid is “linking” the old Medicaid ID number to the new Medicaid ID number. Recipients may continue to use the old Medicaid ID number during June 2024. Once numbers are linked, either number will work. Providers who need assistance may call the Medicaid Provider Assistance Center at 1-800-688-7989. 

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

2024-06-06T16:10:05-04:00June 6, 2024|Alabama|

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