Tennessee
According to the Department of Commerce and Insurance (TDCI) Rule 0780-01-95-.10(1)(b) and 0780-01-95-.10(2)(b), the deadline to submit an attestation of low-volume status and proof of actual prescription volume to your contracted PBMs is December 1, 2024. Volume status is based on your pharmacy's actual prescription volume from July 1, 2023, to June 30, 2024.
Also in Tennessee, the Tennessee Pharmacy Association (TPA) is hosting a Pharmacy Technician Conference on November 16 from 9:00 am to 4:15 pm. Pharmacy technicians are invited to register at one of four locations across Tennessee to advance their careers, earn continuing education (CE) credit (including pharmacy law and patient safety) and develop valuable connections.
Finally, register for the TPA and the Tennessee Pharmacists Consortium for Education's (TPCE's) training program, the PBM Playbook: Mastering MAC Appeals in TN. The three-session training program will be presented by Tyler Dougherty, an esteemed expert in PBM reform and compliance. The sessions are on November 6, November 20 and December 4. Please register in advance.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Commission (HHSC) posted the biannual specialty drug list.
Also in Texas, the Department of State Health Services (DSHS) combined the individual weekly influenza, respiratory syncytial virus (RSV) and COVID-19 surveillance reports into one report called the Texas Respiratory Virus Surveillance Report. A new Respiratory Illness Interactive Dashboard contains respiratory illness data including emergency department visits, hospitalizations and deaths associated with flu, RSV and COVID-19.
Also in Texas, the DSHS offers an Immunization Toolkit with educational resources to help Texans understand the importance of protecting themselves and others with the flu vaccine.
Also in Texas, the quarterly meeting of the Board of Pharmacy will be on November 5. The Board posted the agenda and will livestream the meeting.
Finally in Texas, the Board of Pharmacy posted the October newsletter.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
Gov. Mike Dunleavy (R) signed a bill into law that aims to ensure consumers have access to affordable prescriptions and level the playing field for pharmacies by regulating pharmacy benefit managers (PBMs) House Bill 226 – CHAPTER 61 SLA 24.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts, weekly notice, and monthly bulletin on the Medi-Cal Rx Web Portal:
- Activation of Reject Code 16 – Medi-Cal Rx Program Integrity Update
- Medi-Cal Rx Claim and Prior Authorization Request System Outage – Issue Resolved
- Update: Medi-Cal Rx Claim and Prior Authorization Request System Outage
- Medi-Cal Rx Claim and Prior Authorization Request Submission Outage
- Medi-Cal Rx Weekly Wrap-up for October 11-17
- Commercial JYNNEOS® Vaccine Reimbursement
- Medi-Cal Rx Weekly Wrap-up for October 4-10
- Reminder: Verification of Member Name on Medi-Cal Rx Claims
- Revolved: Medi-Cal Rx Provider Portal Prior Authorization Attachments
- Justice-Involved Reentry Initiative Now Implemented in Inyo, Santa Clara, and Yuba Counties
- Coming Soon: Commercial JYNNEOS® Vaccine Reimbursement Correction
- State of Emergency Override Activation: Submission Clarification Code 13
- Medi-Cal Rx Weekly Wrap-up for September 27-October 3
- Deactivation of Override Code “55555” for All Drugs/Products – Medi-Cal Rx Program Integrity Update
- Medi-Cal Rx Monthly Bulletin for October
- Changes to the Medi-Cal Rx Contract Drugs List
- Changes to the Medi-Cal Rx Contract Drugs List – Over-the-Counter Drugs and Cough/Cold Preparations
- Changes to the Medi-Cal Rx Contract Drugs List – Authorized Drug Manufacturer Labeler Codes
- Changes to the Medi-Cal Rx Pharmacy Reimbursable Physician Administered Drugs
- Changes to the Medi-Cal Rx Family Planning, Access, Care, and Treatment Pharmacy Formulary
- Updates to the Medi-Cal Rx Provider Manual
Also in California, effective September 17, the opioid antagonist protocol was amended. The approved regulation text with changes has been posted by the Board of Pharmacy.
Also in California, starting January 1, 2025, personal license renewal applications will no longer be mailed and licenses that are eligible for renewal will be processed online.
Finally in California, the Department of Health Care Services posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
The Agency for Health Care Administration will ensure reimbursement for all services provided in good faith to eligible Florida Medicaid recipients residing in the Florida counties affected by Hurricane Milton.
For providers within the State of Florida, along with out-of-state providers who are not enrolled with Florida Medicaid and who provided services to our displaced Florida residents, Florida Medicaid created a provisional provider enrollment process. Florida Medicaid has waived some initial requirements for providers to submit normally required information and documentation when applying for provisional enrollment. Details have been published in the “Florida Medicaid Health Care Alert” issued-on October 15, 2024.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
The Department of Health and Human Services (HHS), Iowa Medicaid posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
The Health Coverage Programs (IHCP) issued a Medicaid provider bulletin BT2024166 reminding providers to use the new Gainwell Technologies addresses.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
The Department for Medicaid Services (DMS) and MedImpact issued a bulletin to pharmacies promoting the administration of Human Papillomavirus (HPV) vaccines at pharmacies. Through December 1, 2024, pharmacies will receive a point-of-sale message when billing claims for Medicaid patients that DMS identified as HPV vaccine naive. Pharmacies may bill Medicaid for the product, the administration fee and counseling. NACDS serves on Medicaid’s Pharmacy Technical Advisory Committee (PTAC) that worked with DMS and the health plans to develop and advance the program. Fee-for-service and MedImpact contact information as well as the protocol have been provided to pharmacies.
Also in Kentucky, Medicaid and MedImpact issued bulletins related to MAC appeals and a reminder to pharmacies of their auto refill prohibition policy.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health (LDH) Bureau of Health Services Financing issued a notice informing Medicaid Pharmacy providers of the upcoming beneficiary third party liability (TPL) data migration that will begin on November 4, 2024. The TPL migration applies to pharmacy claims submitted to Gainwell for Fee for Service (FFS) and to Prime Therapeutics for MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections, and UnitedHealthcare).
Also in Louisiana, LDH issued an Informational Bulletin 24-37 updating the immunization fee schedule for 2024-2025.
Finally in Louisiana, on October 1, legislation signed into law by Gov. Jeff Landry (R) made Louisiana the first state to classify mifepristone and misoprostol, two abortion-inducing drugs, as controlled dangerous substances. While the drugs are still available with a prescription, they are now classified in the same category as some opioids.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
COMAR 10.34.42 Pharmacist Prescribing of a Nicotine Replacement Therapy went into effect on October 14. This service is covered by Medicaid for enrolled pharmacies/pharmacists. These regulations are the result of the enactment of SB 62 of 2023 and payment for pharmacy services (Medicaid and commercial plans) as required by HB 1151 of 2023.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
The Board of Pharmacy issued the following two updates:
- Policy 2024-02: Implantable Infusion Pumps – Outlines requirements for extended infusion times of compounded sterile preparations via implanted pumps.
- 247 CMR 13.00: Nuclear Pharmacy Licensure Requirements and Professional Practice Standards – The most significant change was to remove the requirement for the separate nuclear pharmacist license and defer nuclear pharmacist qualifications to the nuclear regulations at 105 CMR 120.526: Training for an Authorized Nuclear Pharmacist.
Also in Massachusetts, MassHealth released the latest Pharmacy Facts that includes a COVID-19 Vaccination Reimbursement Update.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
The Board of Pharmacy posted the Pharmacy Rules Committee Workgroup Agenda for November 4.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
NACDS reminds members that the new Medicaid Management Information System (MMIS) for pharmacy claims is scheduled to be implemented on November 4. For more information, see the Medical Assistance Portal.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Due to numerous questions on the drug shortages caused by the recent hurricanes, the Board of Pharmacy issued guidance to assist licensees.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Montana
Effective December 1, the Montana Pharmacy Association announced several changes: Stuart Doggett, Executive Director, will semi-retire; Deedee Grubs will begin as the association’s Executive Director; and Tony King, PharmD, MBA will serve as its lobbyist for the 2025 Montana Legislative session. Dr. King is currently the Retail Pharmacy Strategy Coordinator at St. Peter’s Health in Helena.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services posted the Excel file of the fee schedule for Injectables October 1, 2024 and published 471-000-540 Nebraska Medicaid Practitioner Fee Schedule for Injectionables.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Jersey
On October 17, A4953 was introduced and on October 24, the Assembly Committee on Financial Institutions and Insurance held a discussion only hearing. The bill titled “Patient and Provider Protection Act” attempts to regulate PBMs by implementing a fiduciary duty and a rate floor. There are some concerns with the legislation that include cost of dispensing and definition of independent pharmacies.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New York
NYRx released an updated Pharmacy Vaccine Billing Guidance, with new fees effective October 24.
Also in New York, on October 16, the State Department of Health hosted its monthly NYRx Pharmacy call. The agenda items included:
- OMIG Restricted Recipient Program: Requirements for primary care providers and pharmacies for patients in this program including new edits taking effect in November 2024 and February 2025, and billing and referral instructions.
- Reimbursement Changes under NYRx: Effective October 1, paying WAC for brand drugs that lack a NADAC (was WAC-3%)
- III. New Guidance Allowing 90-Day Prescriptions and 90-Day Prescribing under NYRx
- NYRx Coverage of OTC Progesterone-Only Contraception: With Opill available, NYRx reminder that they will only cover it for those with Medicaid if they obtain it from a pharmacist who is authorized to dispensing hormonal contraception per new law/ standing order and following patient questionnaire/counseling etc. or with a fiscal order from their prescriber.
- NYRx Compound Policy
- Prior Authorizations: Slides include clarification on NYRx prior authorization policies per a request for guidance.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The following Board of Pharmacy rules have been posted for public comment by the Commonsense Initiative:
- CSI – BIA – Sterile and Non-Sterile Drug Compounding (Comments Due 11.4.2024).pdf
- CSI – BIA – FYR 2024 (Controlled Substances) (Comments Due 11.1.24).pdf (combines existing rules into single section)
- CSI – BIA – FYR 2024 (Pharmacy Technicians) (Comments Due 11.1.24).pdf (extends training period for active-duty military)
- CSI – BIA – FYR 2024 (Prescription Drug Collection) (Comments Due 11.1.24).pdf
- CSI – BIA – FYR 2024 (Probation) (Comments Due 11.1.24).pdf
- CSI – BIA – FYR 2024 (Terminal Distributors of Dangerous Drugs) (Comments Due 11.1.24).pdf
- CSI – BIA – Zoning Requirements (Comments Due 11.1.24).pdf
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
Earlier this month, the U.S. Supreme Court asked the Solicitor General to weigh in on whether a 2019 Oklahoma law establishing minimum, uniform pharmacy network access for patients and prohibiting pharmacy benefit managers from steering patients to obtain their prescription drugs from affiliated pharmacies is preempted by federal ERISA law or should be allowed to stand. The decision to seek the Solicitor General’s opinion follows multiple attempts to get SCOTUS to step in after the Tenth Circuit appeals court last year overturned a lower Oklahoma court ruling in Pharmaceutical Care Management Association v. Mulready.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Pennsylvania
The Senate has unanimously approved Gov. Josh Shapiro’s (D) executive nomination to add James “Jim” Reed to the State Board of Pharmacy. Jim is the Pharmacy Regional Manager for Weis Markets and previously served in several pharmacy leadership roles for Walgreens.
Also in Pennsylvania, Medical Assistance has updated the domain name of the Provider Enrollment application web page.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Tennessee
The Department of Health’s Vaccine-Preventable Diseases and Immunization Program (VPDIP) released “Recommendations for Vaccination After a Flood” addressing recommended vaccinations following flooding events. It includes updated vaccinations for tetanus, hepatitis A, hepatitis B, flu and COVID-19 as well as vaccines for cholera and typhoid.
Also in Tennessee, Blue Cross Blue Shield of Tennessee released its proposed 2025 essential and preferred formulary changes. Removals include Victoza, Humira, brand name Vyvanse and many more. The formulary changes also include new additions, tier modifications, quantity limit additions/removals and new prior authorizations.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Drug Utilization Board discussed these agenda items on October 25.
Also in Texas, the Health and Human Services Commission (HHSC) published the 2024-25 monthly prophylaxis for RSV on October 1. Review the schedule for each region’s start and end dates.
Finally in Texas, the Medicaid Vendor Drug Program (VDP) posted the October specialty drug list.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
During the Board of Pharmacy’s September monthly meeting, the Board discussed the strategic plan to address the findings of the Department of Examiners of Public Accounts (Public Examiners). The plan will be available on the Board’s website.
Also in Alabama, Medicaid issued an ALERT regarding RSV Prevention Criteria for the 2024-2025 season, including the following information.
- Beyfortus® (nirsevimab), a long-acting monoclonal antibody product, was approved by the US Food and Drug Administration (FDA) on July 17, 2023, for use in newborns and infants to protect against (medically attended) respiratory syncytial virus (RSV).
- On August 3, 2023, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) voted unanimously in favor of recommending use of Beyfortus® as indicated in its FDA package insert.
- Beyfortus® will be administered and dispensed through the Vaccines for children Program (VFC) administered through Department of Public Health. Therefore, Beyfortus® will not be eligible for billing through the Medicaid pharmacy program.
Finally in Alabama, Medicaid issued an ALERT on October 1 as a follow-up to the ALERT dated August 1, regarding the new Disclosure Form that is posted on the Alabama Medicaid Agency (Medicaid) website. Effective October 1 and after Medicaid will enforce the new Disclosure Form.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy met on October 10.
Also in Alaska, the Pharmacy Board revised statutes and regulations are now available on the website. Effective September 28, there are significant changes affecting collaborative practice authorities, nationally certified pharmacy technician practices, sterile pharmaceutical guidelines, manufacturer license requirements, prescription drug monitoring program (PDMP) registration, alternative to probation program and “owner” / “change of ownership” definitions.
Finally in Alaska, the Board issued new rules on expanded pharmacy technician duties (2 AAC 52.235. PHARMACY TECHNICIAN WITH NATIONAL CERTIFICATION).
(a) A pharmacy technician who holds a national certification may, at the direction of the pharmacist on duty and under the direct supervision of that pharmacist,
(1) perform a final check of and distribute a non-controlled substance prescription if
(C) the pharmacy uses software that displays the image or graphical description of the correct drug being verified; however, if there is any deviation between the image or graphical description and the actual product being distributed, a pharmacist must review and dispense the order; and (Previous Version)
(C) the pharmacy uses software that displays the image or graphical description of the correct drug being verified, or the institutional facility uses software that performs and verifies a barcode scan before administration [; HOWEVER, IF THERE IS ANY DEVIATION BETWEEN THE IMAGE OR GRAPHICAL DESCRIPTION AND THE ACTUAL PRODUCT BEING DISTRIBUTED, A PHARMACIST MUST REVIEW AND DISPENSE THE ORDER]; and (New Version, Bold and Underlined is added and Bracketed is removed)
For more information, contact NACDS’ Mary Staples at 817-442-1155.