Tennessee
During the most recent Board of Pharmacy meeting, the Board confirmed that rules for technician immunizations will not be finalized before the PREP Act expires. However, technicians should still be able to vaccinate after receiving a waiver from the Board’s Executive Director Lucy Shell. NACDS and Tennessee Pharmacy Association are working to confirm details of this process and will share more information as it becomes available.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Commission (HHSC) implemented a new STAR+PLUS contract in seven managed care organizations (MCOs) on September 1, 2024. Pharmacy claims billing codes and contact information for these MCOs are available.
Also in Texas, HHSC’s Vendor Drug Program (VDP) revised the Pharmacy Payer Specification Manual, separating them by program. The three separate manuals are the Traditional Medicaid and the Healthy Texas Women Program, the Children with Special Health Care Needs Services Program and the Kidney Health Care Program. The three new manuals are available on the VDP Provider Portal.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Department of Medical Assistance Services (DMAS) held an initial virtual meeting with pharmacy associations to discuss the upcoming pharmacy cost-of-dispensing survey (slide deck). The survey instrument has not been finalized; however, Myers & Stauffer intends to send it to pharmacies on September 12. Additional informational webinars for all pharmacy stakeholders are tentatively scheduled for September 24 and September 26.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The State Department of Health Office of Immunizations is hosting a 2024-2025 Respiratory Virus Season: Vaccine Recommendations, Ordering and Distribution webinar on September 17. Presenters will discuss influenza, COVID-19, and RSV epidemiology, vaccine recommendations and vaccine ordering and distribution.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
Effective September 2024, Medicaid will now permit pharmacists to enroll as providers and bill for pharmacy services. This significant development results from collaborative efforts by various pharmacy organizations, including the Alaska Pharmacy Association. The change aligns with HB 145 of 2022. It allows pharmacists to enroll as rendering providers and get paid for their services through medical benefits while affiliated with a pharmacy professional group, Tribal Health Organization, Federally Qualified Health Center or Rural Health Clinic.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
NACDS sent a letter to the Arkansas Insurance Commissioner Alan McClain (R) in support of proposed Emergency Rule 128, Pharmacy Benefits Manager Compensation Requirements for Network Adequacy, Fair and Reasonable Pharmacy Reimbursements. This rule is needed to protect pharmacy providers from the abusive PBM business practices that can jeopardize the future of pharmacy and the sustainability of providing pharmacy services and patient access to care.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
This week the Assembly passed SB 966, PBM Reform legislation. The bill returns to the Senate for concurrence with the Assembly amendments. The legislature will adjourn no later than midnight on August 31.
Also in California, the Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal:
- State of Emergency Override Activation: Submission Clarification Code 13
- Medi-Cal Rx Weekly Wrap-up for August 16-22
- Mass Adjustment for Impacted Blood Factor Claims with a Date of Service October 1, 2021, through December 31, 2021
- Medi-Cal Rx Weekly Wrap-up for August 9-15
- CalAIM Justice-Involved Reentry Initiative Implementation for Inyo, Santa Clara, and Yuba Counties
- Vaccines for Children Program: Medi-Cal Reference Guide
- Coming Soon: Medi-Cal Reimbursement for Vaccines for Children-Enrolled Providers
Also in California, effective for dates of service on or after September 1, 2024, the Department of Health Care Services has updated the List of Contracted Incontinence Creams and Washes.
Also in California, the Board of Pharmacy proposed the following rules:
- Pharmacy Technician Certification Program Documents
- Notice of Proposed Action
- Initial Statement of Reasons
- Proposed Text
- 45-Day Comment Period: August 23, 2024, to October 7, 2024
- Quality Assurance Programs
- Notice of Proposed Action
- Initial Statement of Reasons
- Proposed Text
- 45-Day Comment Period: August 9, 2024, to September 23, 2024
- Please send your company’s comments on the proposed rule to Sandra Guckian by September 10.
- Pharmacy Technician Fee Schedule
- Notice of Proposed Action
- Initial Statement of Reasons
- Proposed Text
- 45-Day Comment Period: July 26, 2024, to September 9, 2024
Finally in California, the Board of Pharmacy’s Licensing Committee added an additional meeting on September 4, 2024, to continue its work on the Standard of Care Model. The agenda, meeting materials and written comments received were posted to the Board’s website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
NACDS is continuing to work with a coalition urging Gov. Jared Polis (D) to expedite implementation of SB24-168, a new law that expands diabetes care access for Medicaid enrollees.
Also in Colorado, Gov. Jarod Polis (D) convened a special session on August 26 to address property tax reform.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Indiana
The Health Coverage Programs (IHCP) issued a bulletin reminding providers requesting an administrative review, also known as a reconsideration, of a denied or partially approved fee-for-service (FFS) nonpharmacy prior authorization (PA), that they must submit a written request to the FFS prior authorization and utilization management (PA-UM) contractor within seven business days of receipt of the PA decision notification.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services cancelled the September 10 meeting of the Drug Utilization Review (DUR) Board. The next DUR Board meeting will be November 12, 2024.
Also in Nebraska, the Medicaid DUR Board is seeking nominations for pharmacists to serve on the board. Board members are required to serve a three-year term with a three-year renewal opportunity. Meetings are held at least quarterly and no more than six times a year (every two months). All interested applicants are required to submit an application via email.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Retail Association of Nevada invited NACDS and their pharmacy members to attend a private fundraiser in Las Vegas for Gov. Joe Lombardo (R). Pharmacists and government affairs representatives Jaime Montuoro with Smith’s, Mark Soltes with Kroger, Lorri Walmsley and Jennifer Kurrie with Walgreens and the former executive director of the Idaho Board of Pharmacy Mark Johnston participated.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Jersey
The New Jersey Legislature announced its fall schedule. The first meeting of the Senate Health Committee will be on October 7. NACDS, along with the New Jersey Pharmacists Association, has asked S1981 to be included on the agenda. The bill, a companion to A1899 which has passed the Assembly, would allow immunization of flu and COVID-19 for those ages 5 years and up and allow pharmacy technicians to administer vaccines.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New York
On August 21, the State Department of Health held its monthly pharmacy call for NYRx transition, the Medicaid Pharmacy Benefit Program. Several relevant agenda items include the following:
- Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) order acceptance policy
- NYRx utilizes the NADAC file which contains historical information for rate/pricing changes. The following provides information on how to read the file:
- The “Effective Date” is the effective date for each rate change. The effective date is designed to avoid overlapping date segments for a specific NDC.
- The “As of Date” indicates the date a rate group first appeared on the NADAC.
- The “Posting Date” is the date in which the NADAC is posted to eMedNY.
- EMedNY cut-off time for file updates occurs every Friday (most NADAC prices show an “As of Date” every Wednesday).
- Information in the pricing file will post to eMedNY every Tuesday.
- NYRx, the Medicaid Pharmacy Program, is making significant changes to the coverage of diabetic testing supplies. These changes align with Medicare coverage criteria.
- NYRx is conducting system enhancements to accommodate vaccine billing by NDC targeted for late October:
- eMedNY systems will automatically apply the administration fee in a single transaction,
- NYRx is committed to making this transition as smooth as possible.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Tennessee
TennCare announced the list of covered UPCs for its upcoming diaper program. Luvs, Pampers, Huggies and Cuties are the primary brands that will be covered. If your pharmacy plans to participate and wants to be featured on the TennCare website as a participating location, complete this survey.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Speaker of the House of Representatives Dade Phelan (R) appointed Mike Toomey as his new chief of staff, replacing Enrique Marquez. Toomey is a former Texas House member, previously served as chief of staff to former Governors Bill Clements and Rick Perry and was most recently a partner at the Texas Lobby Group.
Also in Texas, PCMA presented at the Texas Pharmaceutical Initiative (TPI) Board’s August 20 meeting, claiming that 90% of the prescription dollar goes to pharmacies and pharmaceutical manufacturers, and that PCMA’s industry creates $155 billion in value each year. The TPI Board also received an update from McKinsey consultants on developing a business plan due to the legislature on October 1, 2024. The TPI was established last session by the Texas Legislature and aims to provide cost-effective access to prescription drugs and other medical supplies to individuals receiving health benefits paid for by the state through the Employee Retirement System of Texas (ERS), Teacher Retirement System (TRS), Health and Human Services Commission (HHSC) including Medicaid, The University of Texas System and Texas A&M University System. The next meeting is September 5.
Also in Texas, the Health and Human Services Commission (HHSC) Vendor Drug Program’s VDP Provider Portal allows pharmacies to retrieve weekly payment files, prescribers to submit prior authorizations, and more. VDP encourages pharmacies and prescribers to register for these valuable tools.
Also in Texas, the state’s economic forecast looks bright as Comptroller Glenn Hegar (R) estimates an $18 billion+ surplus, and about $24 billion in the Economic Stabilization (Rainy Day) Fund.
Finally in Texas, pharmacies can request expedited formulary coverage, an expedited preferred drug list change or notify HHSC about potential drug shortages impacting prescribing choice and pharmacy claim processing by using the Drug Shortage Notification and Expedited Formulary or Preferred Drug List Request (HHS Form 1315). Referrals should recommend an alternative with supply chain in mind so extra demand will not cause another shortage.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Commission (PQAC) posted its quarterly newsletter.
Also in Washington, PQAC updated and approved the Nonresident Pharmacy: List of Approved Inspection Programs Directive at the August meeting. The updated version is effective October 1, 2024, for all nonresident pharmacies.
Finally in Washington, the Department of Health (DOH) filed a CR-102 Notice of Proposed Rulemaking amending a section of rule, WAC 246-945-015 Minimum Requirements for Dispensing Practitioners, creating four new sections of rule:
- WACs 246-945-026 Accessible Prescription Information;
- Definitions, 246-945-027 Accessible Prescription Information;
- 246-945-028 Accessibility of Prescription Information for Visually Impaired or Print Disabled Individuals; and
- 246-945-029 Translation and Interpretation for Prescription Information for LEP Individuals.
The proposed rule requires that all dispensing practitioners and dispensing facilities in the state provide prescription information to the patient on the container in a format that can be accurately comprehended by the patient. A public hearing for this proposed rulemaking will be held on October 4, 2024. The CR-102 form and the rule language may be viewed at the following links:
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
Gov. Sarah Huckabee Sanders (R) announced that she is joining Insurance Department Commissioner Alan McClain in imposing penalties and hearings against four PBMs – Caremark, Magellan, Express Scripts and MedImpact – for allegedly violating a June 28 bulletin from the Insurance department advising PBMs to stop paying pharmacies below the national average drug acquisition cost (NADAC).
Also in Arkansas: Attorney General Tim Griffin sues PBMs for alleged role in the state’s opioid epidemic.
Also in Arkansas, effective August 1, 2024, Medicaid Fee-for-Service reimburses pharmacies for diabetes testing supplies and continuous glucose monitors (CGMs) through the pharmacy billing system (Prime/Magellan). This includes diabetes lancets, meters, test strips, CGMs and CGM supplies.
Finally in Arkansas, the Pharmacists Association (APA) shared that Blue Cross Blue Shield (BCBS) is paying pharmacists to capture A1c and other diabetes interventions for some patients through Outcomes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
Gov. Katie Hobbs (D) signed SB 1211 (Chapter 232), legislation allowing pharmacists to dispense naloxone hydrochloride, or any other opioid antagonist approved by the FDA without a signed prescription and removing the requirement that the Board of Pharmacy establish protocols for the dispensing of naloxone hydrochloride and other opioid antagonists.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following alerts, weekly notices and monthly bulletin on the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Weekly Wrap-up for July 26-August 1
- State of Emergency Override Activation: Submission Clarification Code 13
- Medi-Cal Rx Monthly Bulletin for August
- 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 Family Planning, Access, Care and Treatment Pharmacy Formulary
- Updates to the Medi-Cal Rx Provider Manual
- Medi-Cal Rx Weekly Wrap-up for July 19-25
- CalAIM Justice-Involved Reentry Initiative and Medi-Cal Rx
Also in California, this week, SB 966, PBM reform legislation, including provisions prohibiting the use of spread pricing, requiring 100% pass-through of manufacturer rebates to plan sponsors, and prohibiting the steering of patients to PBM-affiliated pharmacies, was placed on the Assembly Appropriations Committee suspense file and must be voted off the suspense file by August 16 to advance to the Assembly floor.
Finally in California, this week, the following bills were placed on the Senate Appropriations Committee suspense file and must be voted off the suspense file by August 16 to advance to the Senate floor:
- AB 1794, legislation clarifying that the value of all property taken over the course of distinct but related acts may be aggregated even though the thefts occurred in different places or from different victims and authorizing counties to operate a program to allow retailers to submit details of alleged shoplifting, organized retail theft or grant theft directly to the county district attorney through an online portal to the district attorney’s internet website.
- AB 82, legislation prohibiting a retail establishment from selling dietary supplements for weight loss or over-the-counter diet pills to any person under 18 years of age without a prescription. Amendments to the introduced language lowered the civil penalties from $1,000 to $250 for each violation and changed the effective date to January 1, 2026.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
On August 19, the Board of Pharmacy is holding a Stakeholder Meeting to receive feedback on proposed changes to the following draft rules:
- Rule 14.00.00 – OTHER OUTLETS – The purpose of the proposed amendments to
Board Rule 14 is to allow off-site dispensing by hospital staff.
- Rule 15.00.00 – WHOLESALERS – The purpose of the proposed amendments to
Board Rule 15 is to update recordkeeping requirements of wholesalers
specifically related to animal drugs.
- Rule 17.00.00 – COLLABORATIVE PHARMACY PRACTICE – The purpose of the
proposed amendments to Board Rule 17 is to update Collaborative Pharmacy
Practice Rules as they relate physician assistants to align them with
superseding regulatory changes around physician assistants.
- Rule 21-00-00 – COMPOUNDING – The purpose of the proposed amendments to
Board Rule 21 is to update controlled substance distribution laws to better
clarify the law and align with federal requirements.
- Rule 17, Appendix A – The purpose of the proposed amendments to Board Rule
17, Appendix A is to update clinical standards and to fix minor clerical errors.
- Rule 3.00.00 – DISPENSING – The purpose of the proposed amendments to Board
Rule 3 is to add a short rule clarifying and referring to the new legislative
requirement of prescription label accessibility from HB24-1115.
- Rule 23.00.00 – ELECTRONIC PRESCRIPTION MONITORING PROGRAM – The
purpose of this Rule Revision is to change the requirement to report pharmacy
data submission delinquency to the Board and give flexibility may changing
“will” to “may” which statute allows.
- Rule 11.00.00 – RECORDS – The purpose of this Rule revision is to update
outdated terminology that no longer exists related to board approval of
electronic record storage.
- Rules 2.00.00 – ORDERS, 3.00.00 -DISPENSING, and 31.00.00 – TELEPHARMACY –
The purpose of the proposed amendments to Board Rule 2, 3, and 31 is to
implement SB24-209 Changes to the Pharmacy Practice Act Regarding
Dispensing of Prescription Drugs, including repeal of Area of Need from
Telepharmacies, updated labeling requirements, and updated functional ability
for technicians.
Also on the Stakeholder Meeting agenda are two new proposed rules:
- Rule 17.00.00, Appendix F – MAT Prescription Protocol – The purpose of the
proposed Rule 17, Appendix F is to create a new MAT Prescribing Statewide
Protocol required as part of implementation of HB24-1045.
- Rule 17.00.00, Appendix E – The purpose of the proposed amendments to Board
Rule 17, Appendix E, is to create a new state-wide protocol of clinical
standards for statin therapy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Florida
For Medicaid recipients, maintaining access to critical Medicaid services is imperative during the State of Emergency related to Tropical Storm Debby. To this end, the Agency will ensure reimbursement for critical Medicaid services provided in good faith to eligible recipients who reside in the counties impacted by the storm. The Agency will waive all prior authorization requirements for critical Medicaid services beginning August 4, 2024, until further notice. Early prescription refill edits have been lifted for all maintenance medications (note: this does not apply to controlled substances).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Family and Social Services Administration’s (FSSA) Indiana Health Coverage Programs (IHCP) Medicaid posted a bulletin with new pharmacy updates approved by the Drug Utilization Review Board July 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
Board of Pharmacy was moved from the Department of Health and Human Services (DHHS) to the Department of Inspections, Appeals and Licensing (DIAL). Upon the transition to DIAL, all health profession programs were combined into one with one set of rules, requiring a common naming convention. The Iowa Monitoring Program for Pharmacy Professionals (IMP3) will now be the Iowa Professional Health Program – Pharmacy (IPHP-Pharmacy). The program’s role is to provide pharmacy professionals and student pharmacists with support for recovery from substance use, mental health issues and other physical conditions.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
The Board of Pharmacy reminded pharmacy technicians that they must pass a national technician certification exam before the first renewal or, if previously registered, at the time of application. The Board approved the Pharmacy Technician Certification Board (PTCB) and the National HealthCareer Association Examination for the Certification of Pharmacy Technicians (ExCPT).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
The Department for Medicaid Services covers items such as wheelchairs, orthotic appliances and disposable medical supplies when ordered by an approved prescriber and are medically necessary. If your pharmacy is enrolled as a Medical Supplies, Equipment and Appliance (MSEA) provider (PT90), you may bill covered nutritional supplements and disposable supplies as a medical benefit under provider type 90. Reimbursement amounts are listed in the Medicaid MSEA Fee Schedule and defined in 907 KAR 1:479. Billing and enrollment instructions are available online. For children under 21 years of age, an item not listed on the MSEA fee schedule may be covered under Early Periodic Screening Diagnosis and Treatment Services (EPSDT) Special Services which requires prior authorization. For assistance, please contact the EPSDT Special Services Coordinator at ivy.sams@ky.gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.