Louisiana

HB 579, the post-exposure prophylaxis (PEP)/pre-exposure prophylaxis (PrEP) bill supported by pharmacies, passed unanimously out of the House. It was amended in the Senate Health and Welfare Committee last week. Next step is to be voted on by the full Senate, and then returned to the House for concurrence. 

Also in Louisiana, the Department of Health (LDH) issued a Bulletin acknowledging that they are working to resolve several issues associated with the implementation of the Single Managed Care Organization (MCO) pharmacy benefit manager (PBM), Magellan (MMA). Pharmacists are encouraged to email Medicaid pharmacy staff directly for assistance. 

Also in Louisiana, the Department of Health (LDH) issued a revised Medicaid Bulletin on April 15, clarifying 340B reimbursement.  

Also in Louisiana, the Board of Pharmacy’s quarterly meeting was held at the Board’s office on May 7 and 8.  

Also in Louisiana, the Department of Health (LDH) posted a plethora of resources for healthcare providers addressing substance use disorder as a treatable medical condition through stigma-free care and ensuring access to treatment options.  

Finally in Louisiana, the Board of Pharmacy posted the agenda for a Public Hearing on May 28 for four regulatory projects – Product Integrity, CDS (Clinical Decision Support) Licensing, Open Meetings via Electronic Means and Prescription Monitoring Program Advisory Council Open Meetings via Electronic Means. 

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

2024-05-09T11:45:11-04:00May 9, 2024|Louisiana|

Maryland

Gov. Wes Moore (D) signed HB 76 and SB 18, legislation that allows pharmacists to provide routine childhood vaccines to children ages 7 years and older. Both measures became effective upon signature.  

Also in Maryland, effective May 1, 2024, Depakote Sprinkle Capsule (divalproex sprinkle capsule) is no longer preferred over its respective generic equivalent. Claims for the brand will now adjudicate only if there is a prior authorization based on an approved Maryland Department of Health (MDH) MedWatch form.  

Finally in Maryland, the Prescription Drug Affordability Board will consider placing price caps on eight drugs soon, including the weight-loss and diabetes drug Ozempic, the attention-deficit/hyperactivity disorder (ADHD) drug Vyvance and an asthma medication called Dupixent. The drugs on the list cost more than $30,000 a year, meeting the board’s criteria as cost prohibitive. (WYPR) 

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

2024-05-09T11:44:33-04:00May 9, 2024|Maryland|

Massachusetts

MassHealth posted a bulletin that MassHealth will not pay for certain high-cost drugs if purchased through the 340B Drug Pricing Program. This change applies to claims for MassHealth members in Fee-for Service, the Primary Care Clinician (PCC) Plan and Primary Care Accountable Care Organizations. Providers serving MassHealth members enrolled in Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), One Care plans, Senior Care Organizations or the MassHealth behavioral health vendor should refer to Managed Care Entity Bulletin 7 for additional information regarding payment policies applicable to those plans.

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

2024-05-09T11:44:04-04:00May 9, 2024|Massachusetts|

Missouri

The Department of Social Services (DSS) MoHealthNet (Medicaid) issued a Provider Bulletin announcing that effective April 1, 2024, due to the decrease in the Missouri Pharmacy Reimbursement Allowance (Pharmacy Tax), the adjustment to account for the Medicaid-reimbursed prescriptions will be decreased. 

Also in Missouri, the Board of Pharmacy emailed Pharmacy Technician Renewals on March 1, 2024, but is concerned that many pharmacy technicians have not renewed. Email address and address changes can be submitted online, faxed to 573/526-3464 or e-mailed. If a name change is required, a copy of the driver’s license, marriage certificate or divorce decree is required. Be sure to include your name and license number on all correspondence to the Board. 

Finally in Missouri, with less than two weeks remaining in the regular session, SB 751, 340B legislation pharmacies support because it allows patients greater access to pharmacies and enhances enforcement provisions, passed the Senate by a vote of 28-3 and is pending further action in the House. 

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

2024-05-09T11:43:31-04:00May 9, 2024|Missouri|

Nevada

The Board of Pharmacy is holding a public hearing in Las Vegas on May 30.

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

2024-05-09T11:42:49-04:00May 9, 2024|Nevada|

New York

On April 17, 2024, NYRx, the New York State Medicaid Pharmacy Benefit Program, held its monthly call for pharmacy providers. On the agenda were long-acting injectable administration, COVID-19 anti-virials, self-administered hormonal contraceptives and Extencilline coverage. Questions and Additional Information: 

  • NYRx claim questions should be directed to the eMedNY Call Center at (800) 343-9000. 
  • NYRx Pharmacy coverage and policy questions should be directed to the NYS Medicaid Pharmacy Policy Unit by telephone at (518) 486-3209 or by email.  

Billing guidelines for Long-Acting Injectable administration: 

Pharmacies will be reimbursed for the medication and an administration fee when billed to NYRx. The member will not have a copayment for drug administration. 

  • NYS legislation requires a patient specific prescription or order for administration. These orders must be kept on file at the pharmacy. 
  • If billing for both the drug and administration, these claims must be submitted separately. 
  • For the drug, the claim must be submitted using the ordering prescriber’s NPI in the Prescriber ID field. The pharmacy will be reimbursed for the medication when billed via National Drug Code (NDC) using reimbursement methodology. For the administration, the claim must be submitted using procedure code 96372, and the pharmacy’s NPI in the Prescriber ID field. A pharmacy will be reimbursed the administration fee of $13.36. 

New York State Medicaid has also notified pharmacies that in response to the ending of the COVID-19 public health emergency on May 11, 2023, effective May 13, 2024, a fiscal order is not required for the first two tests per month. Furthermore, pharmacy reimbursement and covered products available on the pharmacy formulary will be modified. Additional tests may be covered with a fiscal order, when medically necessary. Coverage will be provided for OTC FDA-authorized COVID-19 test kits used in accordance with the Centers for Disease Control and Prevention (CDC) recommendations for antigen detection. This policy for coverage of at-home test kits via NYRx, the NYS Medicaid Pharmacy Program, will remain in effect until further notice. 

If a member needs more than two (2) tests per month, and all other resources were utilized, and the member has a fiscal order, the pharmacy may call the Pharmacy Policy unit at 518-486-3209 for a review of medical necessity. 

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

2024-05-09T11:42:14-04:00May 9, 2024|New York|

South Carolina

Effective July 1, 2024, the South Carolina Department of Health, and Human Services (SCDHHS) will implement a single, state-directed pharmacy benefit preferred drug list (PDL) for all providers enrolled in the Healthy Connections Medicaid program. SCDHHS currently operates a PDL exclusively for Medicaid members who are enrolled in the fee-for-service (FFS) Medicaid program, while each managed care organization (MCO) maintains and operates its own independent PDL. 

The single PDL that will become effective July 1, 2024, will be based on SCDHHS’ current FFS PDL, which is available on the pharmacy section of SCDHHS’ website. A list of frequently asked questions (FAQs) is also available on pharmacy section of SCDHHS’ website. SCDHHS will host two live provider training sessions via online seminar on May 22 from 7:30 am-9:00 am and from 12:30 pm-2:00 pm. Registration information for the provider training webinars, updates to the FAQs and other provider training resources will be announced via a provider bulletin. Providers should email any questions related to this bulletin to SCDHHS’ Office of Pharmacy Services. 

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

2024-05-09T11:40:14-04:00May 9, 2024|South Carolina|

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