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.
California
On September 28, Gov. Gavin Newsom (D) vetoed SB 966, PBM reform legislation that would have required licensure by the Department of Insurance among other provisions supported by NACDS. In his veto message, the Governor said the public and the Legislature need a clearer understanding of how PBM practices are driving up prescription drug costs and explained the need for more granular information to fully understand the cost drivers in the prescription drug market and the role that PMBs play in pricing. Gov. Newsom directed the Health and Human Services Agency to propose a legislative approach to gather much needed data on PBMs next year, which can be considered in conjunction with data from the state’s Office of Health Care Affordability (OHCA) reflective of the state’s entire health care delivery system.
Also in California, effective for dates of service on or after October 1, 2024, the Department of Health Care Services announced Medi-Cal pharmacy providers are eligible to supervise and bill for Community Health Worker (CHW) services when billed with CPT® codes 98960, 98961 and 98962. Modifier U2 is required when Pharmacy providers bill for claims for services rendered by CHWs.
Also in California, the Department of Health Care Services posted the following alerts and weekly notice on the Medi-Cal Rx Web Portal:
- Updated COVID-19 Vaccine Reimbursement Rates
- Medi-Cal Rx Provider Portal Prior Authorization Submission Update: Member Validation Enhancement
- Medi-Cal Rx Weekly Wrap-up for September 20-26
Finally in California, the Board of Pharmacy posted the agendas for the following meetings:
- Enforcement Committee – October 16 – Agenda – Note review of 2024 legislation and discussion and consideration of FDA actions related to the Drug Supply Chain Security Act (DSCSA).
- Licensing Committee – October 17 – Agenda – The following items may be of interest:
- Presentation by the California Pharmacists Association on Assembly Bill 317 (Chapter 322, Statutes of 2023) related to Pharmacist Service Coverage
- Discussion and Consideration of Proposed Changes to Board-Provided Training for Furnishing HIV Preexposure and Postexposure Prophylaxis
- Discussion and Consideration of Proposed Follow-up Survey on Working Conditions
Open Discussion on Payor Practices that Negatively Impact Patient Care
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The Department of Health Care Policy and Financing (HCPF) continues to promote value based payments for prescription drugs and other care to reward improved access to high-quality, equitable and affordable care. In 2022, 36% of Medicaid payments were value-based payments.
Also in Colorado, the fourth annual substance use disorder (SUD) virtual stakeholder forum will be held on October 16. HCPF will review the Annual Report for Demonstration Year 3 and update the community about the 1115 Waiver “Expanding the Substance Use Disorder Continuum of Care.” Participants need to register in advance.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Connecticut
The Department of Consumer Protection updated its website to allow for electronic registration of “pharmacy clerks” as established by legislation passed earlier this year that became effective October 1. This registration is required for any individual who will physically work in an area of a pharmacy or institutional pharmacy where controlled substances or other legend drugs are dispensed by, or under the supervision of, a pharmacist.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Delaware
The Board of Pharmacy is scheduled to hold its regular meeting on October 16 at 9:30 am. On the agenda is a discussion of legislation: HB 383, an Act to prohibit discrimination against 340B drug distribution.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Florida
In anticipation of the impact of Hurricane Milton, Gov. Ron DeSantis (R) issued Executive Order (EO) 24-215, amending EO 24-214 and declaring a state of emergency for 51 counties. The State Surgeon General signed Emergency Order 24-003, which among other items, permits pharmacies and prescription department managers to operate in multiple or mobile locations.
Also in Florida, effective September 30, Florida’s minimum wage increased from $12.00 per hour to $13.00 per hour. This increase is a result of Constitutional Amendment No. 2 passed by voters in the 2020 election. In accordance with the amendment, the minimum wage is set for annual increases on the path to a $15 minimum wage by September 30, 2026. The requirement applies to both public and private employers, regardless of size. Florida Statutes requires employers who must pay their employees the Florida minimum wage to post a minimum wage notice in a conspicuous and accessible place in each establishment where these employees work. Please download the updated 2024-2025 minimum wage poster and display accordingly to ensure you are following posting requirements.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
After six years of service, the Deputy Secretary and Chief of Staff Kim Opsahl departed the Family and Social Services Administration (IFSSA) on October 11.
Also in Indiana, the Health Coverage Programs (IHCP) has a new Claims Submission and Processing Manual.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services (HHS), Iowa Medicaid posted INFORMATIONAL LETTER NO. 2630-MC-FFS 2024 Pharmacy Dispensing Fee Increase. Effective October 1, 2024, the Iowa Medicaid dispensing fee increased from $10.38 to $10.63 based on the 2022 Cost of Dispensing survey.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
MedImpact issued a communication to pharmacies this week as a reminder about each managed care organizations (MCO) lock-in policy, including a list of each MCO’s criteria.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health issued Informational Bulletin 24-33. Open Enrollment for Medicaid members starts on October 15 and ends on December 2. During this period, members may change their health or dental plans without a qualifying reason.
Maine
The Prescription Drug Affordability Board met on October 7. The meeting’s main purpose was to finalize the draft for the questionnaire for public payors and to provide an update from the legislative planning workgroup, specifically concerning LD 1829. The Board is scheduled to meet next on November 25 at 10:30 am.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
The Prescription Drug Affordability Board (PDAB) and Stakeholder Council (PDASC) announced upcoming meeting schedules:
- The Prescription Drug Affordability Board Stakeholder Council (PDASC) will meet on November 4 at 2:00 pm. The meeting information page includes a link to register for the virtual meeting. They will not meet on October 21 or 28.
- The Prescription Drug Affordability Board (PDAB) will only have one meeting in October; a virtual Ad-Hoc meeting is scheduled to be held on October 28 at 2:00 pm. The meeting information page includes a link to register and additional information.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
On October 4, MassHealth released the results of its cost of dispensing study. It was announced that the proposed updated dispensing fee for chain pharmacies will be reduced by $1.51 per prescription from $10.02 to $8.51. This proposed change is scheduled to take effect on July 1, 2025. The dispensing fee for independent pharmacies will be increased by 19 cents to $10.21. The division also announced a policy change that will require managed care organizations (MCOs) to pay the MassHealth fee-for-service rate to independent pharmacies instead of the current managed care contract rate. MCOs will continue to pay chain pharmacies the negotiated contract rate. The raw data from the cost of dispensing survey is expected to be made available within the next two weeks. The proposed amendments will be submitted to CMS for its approval.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.