New Hampshire
The New Hampshire Board of Pharmacy will be holding a hearing on September 25, 2025, at 9:30 am to review the repeal of three rules. The three rules being repealed are (1) in regard to unused prescription drugs, (2) the New Hampshire Controlled Drug Prescription Health and Safety Program, and (3) Continuous Quality Improvement. In lieu of attending, written comments can be submitted to OPLC-Rules@oplc.nh.gov.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New York
On September 5, Governor Hochul signed into law the Retail Workers Safety Act, which requires employers to implement policies and training programs to prevent workplace violence. It requires a retail store with 500 or more employees to install panic buttons in all New York locations. The Department of Labor would be required to create a model workplace violence prevention training program, policy, and guidance document to be utilized by employers. The law is effective March 4, 2025, however the section requiring panic buttons would take effect January 1, 2027.
On September 13, 2024, the New York Pharmacy Conference held its regular meeting. The meeting included updates from Donate Life New York State, the Comprehensive Contraceptive Coverage Act, and Expansion of Collaborative Drug Therapy Management to offsite practices, and a legislative update from Assemblyman John McDonald. The next meeting of the conference will be held on Friday December 13, 2024, at 10 AM.
On September 18, 2024, the New York Department of Health held their monthly pharmacy industry call regarding NYRx, the Medicaid Fee-For-Service Program. This month’s call included updates on Blood Glucose Test Strip Coverage Policy and Covid Tests Coverage Policy Update.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The Board of Pharmacy published the following final rules:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) moved its next meeting from September 18 to October 2 due to unforeseen scheduling issues and lack of a quorum. The agenda has been updated to reflect this change. Please note the “Medicare MFP modeling presentation and SB 192 upper payment limit discussion” by PDAB staff and Myers and Stauffer on the agenda. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
Effective October 1, 2024, over the Counter (OTC) COVID-19 testing kits will no longer be covered under TennCare’s pharmacy benefit due to the end of the COVID-19 Public Health Emergency. Beginning October 1, 2024, Covid Test Kits will remain a covered benefit under the medical benefit.
Effective September 1, 2024, TennCare began reimbursing pharmacy providers through the OptumRx Pharmacy Point of Sale System (POS) for the administration of newly FDA approved COVID-19 vaccines for the 2024-2025 Formulas. Per FDA guidance, previous versions of COVID-19 vaccines are no longer recommended or authorized for use. CoverKids and CoverRx claims also follow this FDA guidance.
Claims for COVID-19 vaccines are exempt from co-pays and script limits for all TennCare enrollees.
COVID vaccine claims for dual eligible members (Both Medicare and Medicaid eligible) will receive NCPDP Reject 65 “Patient has Medicare Coverage, Bill Medicare.”
Please note for TennCare members, effective October 1, 2024, the Covid-19 vaccine reimbursement will change to include only the cost of the vaccine plus the Professional Dispensing Fee (PDF). The $40 administration fee will be discontinued. Therefore, the Incentive Amount Submitted (NCPDP Field 483-E3) is no longer required for claim submission. If you have a TennCare Medicaid ID, you may contract with the individual Managed Care Organization(s) to bill for ancillary services. Please contact the designated health plan Provider Services for assistance.
Also in 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 a list of the preferred agents and the clinical criteria here, and see the list of Tennessee OptumRx Provider Liaisons here.
Finally in Tennessee, the Tennessee Pharmacists Research and Education Foundation (TPREF) is proud to offer an ACPE-accredited OSHA training webinar that meets all of OSHA’s annual training requirements, with ten sessions offered between September 25 and October 23. Register for one of the sessions!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Texas Pharmaceutical Initiative (TPI) Board is meeting on September 23.
Also in Texas, Speaker Dade Phelan (R) appointed Rick Perry (R), former Governor of Texas and Secretary of Energy under the Trump Administration, as a senior advisor to his leadership team.
Also in Texas, the Department of State Health Services (DSHS) resolved the issue of providers receiving errors when submitting Unsolicited Vaccine Updates (VXU) messages through data exchange for influenza vaccines. The seasonal influenza vaccines for 2024–2025 have been updated in ImmTrac2 as of Aug 30, 2024. Please refer to the Fall Season Respiratory Vaccine Codes | Immunization Information Systems (IIS) | CDC for the correct codes to report for influenza 2024–2025 vaccines to ImmTrac2.
Finally in Texas, the Senate Health and Human Services Committee held a hearing focused on expanding access to healthcare services and NACDS submitted a support letter.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
The Board of Pharmacy will be holding its regularly scheduled meeting on September 25, 2024, at 9:00 am. The meeting will be hybrid and recorded.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Alabama
Mandatory provisions of the Affordable Care Act require the Medicaid Agency (Medicaid) to select and provide oversight for a Medicaid Recovery Audit Contractor (RAC) to perform provider audits. Alivia Analytics, LLC (Alivia) was selected to be Medicaid’s RAC effective October 1, 2024. The RAC program is designed to improve payment accuracy by identifying under and overpayments in Medicaid. The Medicaid RAC program is separate from the Medicare RAC overseen by the Centers for Medicare and Medicaid Services.
Reviews will be conducted by Alivia staff to include a medical director, certified professional coders and experienced clinicians. Audits will be conducted by Alivia using a “top down” approach where data analysis, through data mining, is applied against the universe of paid claims to identify patterns of utilization or billing which look atypical based on Medicaid and/or national standards. Following the high-level claims analysis, Alivia may expand its review by requesting clinical records and/or other documents in accordance with state and federal regulations.
Alivia has been informed of the critical role that all providers play in a successful Medicaid program and requires that auditors be professional, objective and consistent in performing all required audits/reviews.
Providers are reminded that the Alabama Administrative Code, the Provider Manual and their Provider Agreements require compliance with requests for medical records for Medicaid program audits.
Questions regarding the audits should be directed to Jamie Cousins, RAC Program Manager, at (334) 353-8025 or Yulonda Carter, Recipient Review Associate Director, at (334) 242-5161.
Also in Alabama, the State Board of Pharmacy will transition to a new database in October of this year. The new system and the renewal process will look different. The changes will ultimately be positive but require you to create a new account to renew licenses, permits and registrations.
Finally in Alabama, as a reminder, 2024 is a year for pharmacist license renewals and pharmacy permit renewals.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy adopted regulation changes in August related to pharmacy technicians, collaborative practice authorities, sterile pharmaceutical guidelines, manufacturer license requirements, PDMP registration, alternative to probation program and definitions. The regulation changes were reviewed and approved by the Department of Law, signed and filed by the Office of the Lieutenant Governor on August 29, 2024, and are effective on September 28, 2024. The filed version of the regulations will be posted in Register 251, October 2024 of the Alaska Administrative Code.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
Last week, the State Assembly passed an amended version of SB 966, PBM Reform legislation, and the State Senate concurred with the amended version. Upon passage, the bill was ordered to “engrossing and enrolling” after which it will be presented to Gov. Gavin Newsom (D) for signature. The governor has until September 30 to act. The bill requires PBMs to apply for a licensure from the California Department of Insurance by January 1, 2027; clarifies the State Attorney General retains all authorities to maintain or restore competitive, fair and honest markets and prosecute state and federal antitrust and unfair competitive violations; prohibits retroactive fees; and would allow a pharmacy that is not owned by the PBM to participate in a PBM network as a preferred provider if the pharmacy is willing to accept the same terms and conditions. NACDS sent a letter to Gov. Gavin Newsom (D) urging him to sign SB 966 to help preserve and expand patient access to pharmacists, pharmacies of all sizes and the Californians they serve.
Also in California, last week, AB 3063 passed the state legislature and was ordered to “engrossing and enrolling” after which it will be presented to Gov. Gavin Newsom (D) who has until September 30 to act. This legislation states the addition of a flavoring agent to a conventionally manufactured product is not considered compounding if certain conditions are met. It also requires the addition of the flavoring agent to be documented in the prescription record.
Also in California, the Department of Health Care Services posted the following alerts and weekly notice and monthly bulletin on the Medi-Cal Rx Web Portal. Please note the MAIC 30-day pharmacy provider notice; rates will be effective October 1, 2024, and were to be posted to the Mercer Medi-Cal Rx website no later than September 1, 2024.
- COVID-19 Vaccines and Vaccine Administration Coverage for Family PACT End-Dated
- COVID-19 Antigen Over-the-Counter Test Coverage Updates, Effective October 1, 2024
- Updates to the List of Contracted Enteral Nutrition Products, Effective October 1, 2024
- Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice
- Medi-Cal Rx Monthly Bulletin for September
- 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
- Updates to the Medi-Cal Rx Provider Manual
- Vaccines for Children Program Policy and Billing Guidance for Pharmacy Providers
- Medi-Cal Rx Weekly Wrap-up for August 23-29
Finally in California, the Board of Pharmacy posted the agenda and meeting materials for the Full Board Meeting on September 12, 2024. Please note the discussion and action related to awarding a contract for medication error reporting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Gov. Jared Polis (D) announced his new chief of staff, David Oppenheim, replacing Alec Garnett, who has been in that role since January 1, 2023. Garnett has accepted the position of vice president for government and regulatory affairs for the University of Colorado Health.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Florida
The purpose of this alert is to provide an update to the previous provider alert issued on August 4, 2024, regarding Hurricane Debby.
The following flexibilities/waivers offered to providers in the alert issued on August 4, 2024, expired at 11:59 pm on September 3, 2024:
- Waiver of prior authorization requirements for critical Medicaid services
- The lifting of early prescription refill edits will remain in place in accordance with Gov. Ron DeSantis’ emergency executive orders issued for Hurricane Debby
- Waiver of service limitations to ensure a recipient requiring critical Medicaid services during the storm receives such care
- Temporary postponement of the Preadmission Screening and Resident Review processes
Additional questions from providers may be directed to the Florida Medicaid Contact Center at 1-877-254-1055
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
The Department of Healthcare and Family Services’ (HFS) Pharmacy Benefit Management System (PBMS) for the fee-for-service program, Change Healthcare, experienced a nationwide system outage as noted in the provider notice dated February 22, 2024. During the system outage, HFS was unable to add new National Drug Codes (NDCs) to the formulary. Providers were asked to hold fee-for-service (FFS) claims until the issue was resolved.
The new NDCs are now available and have been added to the formulary; therefore, providers may release all FFS claims that have been held pending the update.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) is hosting an informational online seminar on the PathWays for Aging program on September 12 at 9:00 am. The presentation by OMPP staff will provide a post-implementation update of the PathWays program which launched on July 1, 2024. The online seminar will be recorded and posted on the PathWays stakeholder engagement website. You can view the online seminar on Zoom or the FSSA YouTube page at the time of the event.
Also in Indiana, FFSA pharmacy updates were approved by Drug Utilization Review Board at the August 2024 meeting.
Finally in Indiana, the Health Coverage Programs (IHCP) posted a bulletin reminding providers of administrative review requirements for fee-for-service prior authorization.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services (HHS) announced the intent to award a Managed Care Organization (MCO) contract to Iowa Total Care. The new Iowa Medicaid contract period begins July 1, 2025, with no change in operations. This RFP and resulting contract aligns all three MCO contracts (Iowa Total Care, Molina, and Wellpoint Iowa, Inc.) to provide health care services to Iowans to the same contract cycle. All three MCO contracts will have a final contract end date of June 30, 2031.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
Medicaid issued a bulletin revising the launch date for its Medicaid Provider Enrollment Rebaseline, which means new managed care organization (MCO) credentialed providers that have not enrolled with Medicaid will receive an invitation letter to enroll through the web portal. The invitation letter will provide specific provider information along with detailed instructions needed for the enrollment process.
Also in Louisiana, Medicaid issued a revised bulletin with contact information outlining the available options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCOs) and the state’s fee-for-service claims processor, Gainwell Technologies. Unless explicitly notated, providers should first seek resolution with the MCO or Gainwell directly, prior to engaging the Department of Health or other third parties.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
On September 5, the Board of Pharmacy held its regular meeting. The agenda included licensure by endorsement and a central fill data collection pilot project.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
The Prescription Drug Affordability Board (PDAB) has rescheduled its September 23 Board meeting for September 10. Registration is required to participate. The Board welcomes public comment and input on all its work. Additional information about providing public comment can be found on the Board Meetings page of the PDAB’s website.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
The Board of Pharmacy issued notice that licensing of non-resident pharmacies will become available in the coming months. At least one pharmacist at each non-resident pharmacy must hold a Massachusetts pharmacist license. (This pharmacist does not have to be the store’s pharmacist-in-charge.) In preparation for non-resident pharmacy licensing, it is strongly recommended to begin the licensing process for the pharmacists as the process can take 30-60 days. Applications and instructions can be found online. Please see the FAQ document for other information regarding non-resident pharmacy licensing.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
The Department of Health and Human Services issued a final bulletin related to the end of COVID flexibilities for OTC (Over-the-Counter) COVID tests and pharmacies as labs.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Effective September 6, 2024, brand name Adderall XR® will no longer be preferred on the MO HealthNet Preferred Drug List (PDL). Dextroamphetamine/Amphetamine ER capsules (generic Adderall XR®) is currently a preferred agent on the PDL and will continue to remain a preferred agent. Please reference the List of Preferred & Non-Preferred Products, as well as the ADHD, Amphetamines Long Acting PDL edit for more information. Maximum Allowable Cost (MAC) rates will apply to brand and generic products. Providers who dispense the brand product without a prior authorization (based on medical necessity) will receive MAC reimbursement.
Also in Missouri, on August 29, the Medicaid Audit & Compliance (MMAC) launched the new secure Provider Communications Portal, which is an efficient method for providers and MMAC to communicate and exchange information and records.
Finally in Missouri, effective August 29, MO HealthNet expanded coverage of Continuous Glucose Monitors (CGMs) to participants currently diagnosed with Gestational Diabetes allowing this vulnerable population to obtain a CGM without prior authorization. Claims for a CGM will auto-approve if the participant has had a gestational diabetes diagnosis billed to MO HealthNet recently or if the pharmacy submits the appropriate gestational diabetes diagnosis code with the claim. Any MO HealthNet participant who currently utilizes insulin can also obtain a CGM without prior authorization.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Board of Pharmacy posted the agenda (revised August 29, 2024) for its September 9 meeting.
Also in Nebraska, new income guidelines increased the number of families who could qualify for the Women, Infants and Children (WIC) supplemental nutrition assistance program. The WIC program is a federally funded program and is an equal opportunity provider. The maximum income allowed for participation in WIC increased. Some families not eligible for the program in the past may now be eligible. Nebraska WIC serves every county in the state with 13 main agencies and over 100 sites.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
North Carolina
Medicaid is committed to supporting increased adoption and utilization of the Board of Pharmacy statewide protocols authorized by legislation. As part of this commitment, effective August 1, 2024, immunizing pharmacists began to receive reimbursement for clinical services provided when utilizing the statewide Nicotine Replacement Therapy (NRT) Protocol. This bulletin applies to Medicaid Managed Care and Medicaid Direct. The claim should be submitted using a medical claim and payment will be issued to the pharmacy.
Also in North Carolina, effective September 1, 2024, Medicaid began covering condoms and spermicides as over-the-counter products, through the pharmacy benefit. This coverage applies to both Medicaid Direct and Managed Medicaid Plans. Coverage supports reproductive health care for Medicaid beneficiaries, including prevention of unintended pregnancy and sexually transmitted diseases. Medicaid beneficiaries will be able to obtain condoms and spermicides from pharmacies enrolled in Medicaid with a prescription from a Medicaid-enrolled provider, with no cost sharing responsibility.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Board of Pharmacy issued draft rules to implement SB 144, the new pharmacy immunization expansion law that passed in July. We have reviewed the rule and found no issues or concerns and intend to file a letter of support. However, if members have any concerns or comments, please share them with Jill McCormack by September 13.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) posted the draft agenda for its next meeting on September 18. Please note the “Medicare MFP modeling presentation and SB 192 upper payment limit discussion” by PDAB staff and Myers and Stauffer on the draft agenda. You must register in advance of the meeting to participate.
Also in Oregon, NACDS, as a participant in the PBM Working Group, submitted a letter to Rep. Rob Nosse (D), Chair, House Behavioral Health and Health Care Committee, to provide comments and pharmacy reimbursement concepts in advance of the next working group meeting scheduled to be held on September 18.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.