Louisiana
The Department of Health (LDH) issued several bulletins:
- Louisiana Medicaid Pharmacy Single Preferred Drug List (PDL) Update – Effective July 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Edits for Vonoprazan (Voquezna®), Sitagliptin (Zituvio™), and Budesonide (Eohilia™) – Effective July 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates – Effective July 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Quantity Limit – Effective July 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirement – Effective July 1, 2024
Also in Louisiana, three PBM reform bills pharmacies supported were sent to Gov. Jeff Landy (R) to be signed into law. SB 444 prohibits reimbursement below cost, HB 603 adds guardrails for PBM audits and SB 281 enhances the Attorney General’s enforcement authority over audits.
Finally in Louisiana, LHD created an on-line form allowing anyone to request a Medicaid Policy change.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Michigan
The Department of Health and Human Services (DHHS) released the presentation from the June Medicaid Pharmacy Liaison Meeting. The slides include information on performing MTM (Medication Therapy Management) for HIV (Human Immunodeficiency Virus) treatment and COVID extensions that will end on September 30, 2024.
Also in Michigan, the Board of Pharmacy has posted the minutes from the June 4 regulation workgroup meeting.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
Several years of ongoing advocacy on priority issues resulted in a remarkably successful 2024 Legislative Session for pharmacy. At the end of session, Gov. Tim Walz (D) signed Chapter 127 into law. The law includes the following reimbursement and scope of practice advances: 1) expanded pharmacy immunization authority to align more closely with the PREP (Public Readiness and Emergency Preparedness) Act by allowing pharmacists and technicians to immunize children for flu and COVID at age 3 years and all ACIP at age six years; 2) mandates that commercial insurers cover pharmacy-based services 3) increases the Medicaid FFS (Fee-for-Service) Dispensing Fee from $10.77 to $11.55 4) clarifies the definition of U&C (usual & customary) to exclude discount card programs; and 5) authorizes pharmacists to test for and administer PrEP (pre-exposure prophylaxis) and PeP (post-exposure prophylaxis) medications. NACDS has worked diligently during the last four session cycles with in-state partners and members to achieve these goals.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Department of Health and Senior Services (DHSS) issued an updated naloxone standing order so that the prescription updates include the most evidence-based formulations and doses.
Also in Missouri, the Board of Pharmacy’s June 2024 newsletter is now available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
To increase access to over-the-counter (OTC) emergency contraception, the OTC progestin-only birth control pill and OTC home pregnancy tests, the Department of Health’s standing order allows Medicaid patients to access these OTC items from the pharmacy and covers these items at pharmacies.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Ohio
The Board of Pharmacy has posted the following updates:
- 202404 – April 9, 2024 Board Meeting Minutes.pdf
- 202404- April 15, 2024 Conference Call Minutes.pdf
- 202405 – May 1, 2024 Conference Call Minutes.pdf
- 202405 – May 15, 2024 Conference Call Minutes.pdf
- 202405 – May 22, 2024 Conference Call Minutes.pdf
- 202405 – May 29, 2024 Conference Call Minutes.pdf
- 202405 – May 8, 2024 Conference Call Minutes.pdf
- CSI – BIA – Criteria for Licensure (Comments Due 6.24.2024).pdf
- CSI – BIA – EMS (Comments Due 6.24.2024).pdf
- CSI – BIA – Recordkeeping (Comments Due 6.24.2024).pdf
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The Health Care Authority (OHCA) provided public notice of a proposed change in methods and standards for setting payment rates for services in the SoonerCare (Medicaid) program. Contingent upon CMS’ approval, effective July 1, 2024, the OHCA will reimburse pharmacists at a rate equal to other providers when providing services within their scope of practice. Vaccine administration is the only claimable service determined to be within the scope of practice of pharmacists at this time. The state plan amendment (SPA) establishes that services provided by pharmacists will be reimbursed in accordance with the reimbursement methodology currently established for physician services.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Pennsylvania
Last week, the House of Representatives’ Children and Youth Committee advanced HB 2037, which would expand pharmacy’s ability to immunize children. The bill would allow pharmacists to administer ACIP vaccines to kids aged 5 years and older and allow pharmacy technicians to immunize children aged 8 years and older for flu and COVID. NACDS has been actively engaged in advocacy on the bill. The bill is now eligible for a vote by the full Senate.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Effective for dates of service on or after August 1, 2024, the Department of Health and Human Services (SCDHHS) will require prior authorization (PA) for the physician-administered drugs in the document linked below to ensure use is consistent with the medication’s indication(s) and appropriate clinical guidelines. This change only applies to medications administered to Healthy Connections Medicaid members enrolled in the fee-for-service (FFS) Medicaid program.
The list of physician-administered drugs for which a PA is required when administered to a FFS Medicaid member is available in the Procedure Codes section of the Physicians Services provider manual on the SCDHHS website. The list in the manual will be updated with the additional physician-administered drugs requiring a PA beginning August 1, 2024. The list of additional drugs is available online.
Requests for PA and questions about this bulletin should be submitted to Magellan Rx Management at https://MRxGateway.com or by calling 1-800-424-8219 between 8:00 am-5:00 pm Monday-Friday.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
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 the lists of the preferred agents and the clinical criteria and see the list of Tennessee OptumRx Provider Liaisons.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Board of Pharmacy (TSBP) adopted and proposed several new rules at the May 7 Board meeting.
Also in Texas, the Pharmaceutical Initiative (TPI) met this week to discuss how to provide greater, more cost-effective access to prescription drugs and essential medical supplies for the health plans for state employees, retirees, Medicaid and CHIP. The three-member Board focused on developing a business plan and hiring an Executive Director.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
On June 10, the Department of Vermont Health Access (DVHA) informed pharmacy providers of some important updates in the restoration of pharmacy services that were implemented in the Medicaid system, effective June 8.
- Drug Pricing Updates:
NADAC (National Average Drug Acquisition Cost), AWP (Average Wholesale Price), FUL (Federal Upper Limit) and SMAC (State Maximum Allowable Drug Cost) drug pricing will be updated to reflect the most accurate and up-to-date pricing information.
- New Drug Products and NDC (National Drug Code) Updates:
The Medicaid system will be updated to include the latest Medispan drug files which will add new drug products and NDCs that have been missing during the restoration process. This update will enhance Medicaid’s database with comprehensive information regarding the latest medications available.
- SMAC Disputes:
Medicaid updated its contact information for SMAC disputes. Please note the updated email address below:
- Email: smacdisputes@optum.com
- Rejected Claim Issues:
Pharmacy Providers with claims still requiring assistance from the system outage (February 21, 2024 – March 18, 2024), please contact the Pharmacy Helpdesk at CHC/Optum for assistance.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Washington
The Health Care Authority (HCA) is hosting a webinar on June 25 at 11 :00 am Pacific time to educate providers on Apple Health (Medicaid) eligibility, benefits and expansion.
Also in Washington, Apple Health’s new point-of-sale system is live and processing claims. Providers are reminded to update to the new billing information for fee-for-service (FFS) clients:
- New BIN = 024822
- New PCN = DRWAPROD
- New Group = CAID
Also In Washington, Apple Health’s new fax number is 833-991-0704.
Also in Washington, the Chief Science Officer signed an updated standing order that allows pharmacies to dispense the naloxone products to eligible persons and entities.
Also in Washington, HCA (Health Care Authority) published a revised Prescription Drug Program Billing Guide.
Finally in Washington, the Pharmacy Quality Assurance Commission (PQAC) is accepting applications to fill current and upcoming public member and pharmacist member vacancies. To qualify for a public member position, an individual must be a resident of Washington State and not affiliated with any aspect of pharmacy. To qualify for a pharmacist member position, an individual must be a resident of Washington State and, at the time of their appointment, have been a licensed pharmacist in Washington State for at least five consecutive years immediately preceding appointment.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Medicaid will begin to migrate the remaining recipients from the Alabama Medicaid Agency Eligibility System (AMAES) to the newer Centralized Alabama Recipient Eligibility System (CARES) in June 2024. Medicaid anticipates the process will be completed by July 1, 2024.
Medicaid recipients with a Medicaid ID number starting with 500 will get a new Medicaid ID number that starts with 530 (unless they already have a 530 Medicaid number). New Medicaid cards will be sent to recipients who do not already have a Medicaid card with the new 530 number.
Recipients in nursing facilities may receive a new Medicaid number but not a card. Medicaid is “linking” the old Medicaid ID number to the new Medicaid ID number. Recipients may continue to use the old Medicaid ID number during June 2024. Once numbers are linked, either number will work. Providers who need assistance may call the Medicaid Provider Assistance Center at 1-800-688-7989.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Arizona
The Board of Pharmacy will meet on June 19 and 20. Visit the Board’s website in advance to review the agenda.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Servies posted the following alerts, weekly report and monthly bulletin on the Medi-Cal Rx Web Portal. Please note the "Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice". Rates will be effective July 1, 2024, and were posted to the Mercer Medi-Cal Rx website no later than June 1.
- Medi-Cal Rx Claims and Prior Authorization Submission Outage – System Issue Resolved
- Enteral Nutrition Updates to the List of Contracted Enteral Nutrition Products, Effective September 1, 2024
- Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice
- Medi-Cal Rx Monthly Bulletin for June
- 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 Pharmacy Reimbursable Physician Administered Drugs
- Updates to the Medi-Cal Rx Provider Manual
- Medi-Cal Rx Weekly Wrap-up for May 24-30
- Medi-Cal Rx Checkwrite Schedule – State Fiscal Year 2024-25 Available
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
HB24-209, practice act expansion, passed both houses and was sent to Gov. Jared Polis (D) to sign into law.
Also in Colorado, the Department of Health Care Policy and Financing (HCPF) submitted an 1115 Waiver Amendment requesting to the CMS an amendment to Colorado's Expanding the Substance Use Disorder Continuum of Care Section 1115 demonstration waiver (1115 SUD (substance use disorder) waiver). For additional information and the entire amendment, contact hcpf_1115waiver@state.co.us.
Finally in Colorado, Gov. Jared Polis (D) signed HB24-1322, legislation providing Medicaid coverage for housing and nutrition services. HCPF (Department of Health Care Policy and Financing) now has the authority to pursue a Health-Related Social Needs (HRSN) 1115 demonstration waiver amendment to expand health-related social needs (HRSN) housing and nutrition services and support for certain eligible Health First Colorado (Medicaid program) members.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Connecticut
On June 4, the Department of Consumer Protection updated the proposed opioid warning label regulation upon some corrections from the Legislative Commissioner's Office.
The Department of Consumer Protection has also given notice that it proposes to adopt a regulation concerning Emergency and Hormonal Contraceptives. Public comment period is 30 days from June 4.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Florida
The University of Florida (UF) Health has been selected by the Centers for Disease Control and Prevention to lead a program that could reduce the health disparity gap in some Jacksonville communities by connecting patients with community pharmacists for help managing high blood pressure.
The Hypertension Pharmacists' Program is scheduled to start this summer with the goal of expanding access to blood pressure care for the city's medically underserved, predominantly Black communities.
The program aims to increase treatment for high blood pressure by embedding clinical pharmacists within a patient's primary care team. The effort, facilitated by the UF Health Jacksonville Office of Community Engagement, is a collaboration among the UF Health Total Care Clinic – Jacksonville, the UF College of Pharmacy and Panama Pharmacy, and it will allow patients to see a specially trained pharmacist at a community pharmacy and seek individualized care and education.
Also in Florida, beginning July 1, 2024, hearing services for UnitedHealthcare of Florida, Inc. (United) will be provided by Audiology Distributors, LLC dba HearUSA. United is a Statewide Medicaid Managed Care plan operating in regions 3, 4, 6 and 11.
Providers that are out of network for hearing services as of July 1, will be eligible for a 60-day continuity of care period where claims will be payable to allow time for members to transition to a new provider, if necessary. All members were notified by mail of this transition. Members can still see their provider for up to sixty (60) days if they are currently receiving care from that provider. The continuity of care period will end on August 30.
If you are interested in becoming a participating provider with United for hearing services, please call HearUSA Member Services at 855-917-1967 or visit the HearUSA website.
For questions regarding this transition, contact United's Customer Service Department at 1-877-842-3210.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
Health Coverage Program (IHCP) provided Pharmacy updates approved by Drug Utilization Review Board May 2024.
Also in Indiana, the Family and Social Services (FSSA) is launching a new Medicaid program called Indiana PathWays for Aging starting July 1.
Finally in Indiana, IHCP (Health Coverage Program) issued a bulletin correcting errors on Vaccine for Children (VFC) vaccine administration codes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2585-MC-FFS Avastin® (bevacizumab) Billing.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
Effective June 1, 2024, the Department for Medicaid Services made changes to the vaccine coverage for Medicaid Fee-for-Service members.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The legislature adjourned sine die on June 3.
Also in Louisiana, several bills' pharmacies supported passed both houses and were sent to Gov. Jeff Landry (R) to be signed into law.
HB 579 – Allows pharmacists to test and treat for PEP/PrEP (See NACDS' letter to the governor supporting enactment of this legislation.)
SB 444 – Prohibits reimbursement below cost
HB 603 – PBM audits
SB 281 – PBM Enforcement and audits
Finally in Louisiana, the Department of Health issued the preferred drug list update for July 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The Prescription Drug Affordability Board (PDAB) announced the June virtual meeting of its Stakeholder Council, scheduled for 2:00 pm on June 24. The agenda and other meeting materials will be available on the Stakeholder Council page of the PDAB's website prior to the scheduled meeting. To register for the June 24 virtual meeting, please click on this link and enter the required information. After registering, you will receive a confirmation email containing details about joining the meeting. Also, to register for oral public comment and for additional information concerning public comments, please refer to the Stakeholder Council page.
Also in Maryland, please visit the Prescription Drug Affordability Board's, Cost Review Study Process page on the Board's website to learn more about the comment period for "Board Selected Drugs for Cost Review." The 60-day comment period will close on July 22, 2024.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
MassHealth published its June “All Provider Bulletin 391” with orders ALL 361, ALL 376 and ALL 380 announcing the start dates for enforcing the ordering, referring and prescribing (ORP) requirements. With the exception of the information in the bulletin, all information in ALL 361, ALL 376 and ALL 380 remains in effect. Opportunity for payment of claims initially denied due to unenrolled ORP provider as described in ALL 376, billing providers should take certain steps to avoid claim denials due to unenrolled ORP providers. If a claim is denied because of an unenrolled or unauthorized ORP provider on or after June 9, 2024, the claim will be placed in suspense status. The claims system will continue to check to see if the ORP provider has enrolled with MassHealth for up to 90 days after the first date of service on the claim. Once the ORP provider is enrolled, the claim will then be payable. This will allow billing providers time to follow the steps related to unenrolled ORP providers outlined in ALL 376. If the ORP provider is not enrolled by 90 days from the first date of service on the claim, the claim will be denied. Also, effective June 9, 2024, billing providers can resubmit claims that were previously denied due to an unenrolled or unauthorized ORP provider if the first date of service on the claim is no earlier than September 1, 2023. If the ORP provider is enrolled with MassHealth within 90 days of the first date of service on the claim, the claim will be payable.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.