In The States – Page 25 – Weekly news about states

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.

Michael Silber2024-05-30T10:24:06-04:00May 30, 2024|Mississippi|

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.

Michael Silber2024-05-30T10:23:31-04:00May 30, 2024|Montana|

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.

Michael Silber2024-05-30T10:22:38-04:00May 30, 2024|Nevada|

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.

Michael Silber2024-05-30T10:22:07-04:00May 30, 2024|New York|

Oklahoma

SB 232, legislation that will allow 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, was sent to a House/Senate conference committee on May 28 to work out the differences. The Legislature is scheduled to adjourn its regular session by 5:00 pm on May 31.

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

Michael Silber2024-05-30T10:21:34-04:00May 30, 2024|Oklahoma|

Oregon

The Board of Pharmacy posted the May 2024 newsletter with updates on the 2024 legislative session and rulemaking.

Also in Oregon, Emma Sandoe, PhD, MPH, has been appointed as the permanent director of Oregon’s Medicaid program, effective July 24. Since 2019, Dr. Sandoe has served in North Carolina’s Medicaid program most recently as the Deputy Director of Medicaid Policy.

Finally in Oregon, the Board of Pharmacy is seeking licensed pharmacists, physicians and advanced practice registered nurses to serve as subject matter experts (SMEs) for the Public Health & Pharmacy Formulary Advisory Committee. The board utilizes SMEs to develop and revise protocols in the Protocol Compendium per OAR 855-115-0345. SMEs will be selected using an application process to ensure representation of diverse practice settings. If you would like to serve as a SME for the PHPFAC, please complete the online form by June 5; scroll down the webpage to access the online volunteer form. Individuals selected will receive confirmation by June 21. Note: Current SMEs, please complete and submit the form so that the board has your current contact information. 

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

Michael Silber2024-05-30T10:21:11-04:00May 30, 2024|Oregon|

South Carolina

The Department of Health and Human Services (SCDHHS) will cover, for a limited time, imported benzathine benzylpenicillin (Extencilline) for use in outpatient medical drug claims when billed with HCPCS code J0561 and at an outpatient pharmacy (point-of-sale). This policy change to provide temporary coverage is to address the ongoing shortage of Bicillin® L-A (penicillin G benzathine injectable suspension). A letter with important prescribing information for Extencilline has been provided to healthcare providers.

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

Michael Silber2024-05-30T10:20:29-04:00May 30, 2024|South Carolina|

Tennessee

Despite strong opposition from employer groups and insurance brokers speaking out against any PBM enforcement, new proposed rules by the Department of Commerce and Insurance which will enact Public Chapter 998 and allow Tennessee Department of Commerce and Insurance to audit PBMs were approved by the Government Operations joint committee and will take effect on June 25, 2024. Thank you to Tennessee Pharmacy Association (TPA) CEO Anthony Pudlo, who testified before the Joint Government Operations Committee in support of these rules.

Also in Tennessee, if you would you like to serve on TPA’s new Specialty Pharmacy Committee, please complete this form to express your interest. The Committee Chair will make committee appointments in the coming weeks, so please respond soon.

Finally in Tennessee, TPA is looking for Champion Advocates across the state to build relationships with their elected officials and help identify physicians who may advocate for the pharmacy profession. Sign up to become a TPA Champion Advocate!

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

Michael Silber2024-05-30T10:19:57-04:00May 30, 2024|Tennessee|

Texas

On May 28, Texans returned to the polls for runoff elections to decide which Democratic and Republican nominees will be on the November ballot as several races failed to receive more than 50% of the vote in the primary election in March. There were eight US Congressional races, one of which is too close to call with only an 8-vote difference between the two Republican candidates vying for CD 35. In the State Senate, there were two open seats due to one retirement and one running for another office. The State House of Representatives will look much different in 2025, with nine incumbents losing in the March primaries, and seven more incumbents losing their runoffs on May 28. Of the eight Republican incumbents forced into a runoff, only Speaker Dade Phelan (R) and Dr. Gary VanDeaver (R) won their races. The chair of the House Public Health Committee and good friend of pharmacy, Stephanie Klick (R), lost her race.

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

Michael Silber2024-05-30T10:19:23-04:00May 30, 2024|Texas|