In The States – Page 38 – Weekly news about states

Maine

The Department of Health and Human Services (DHHS) announced it is expanding interim pharmacy payments to include pharmacies that are part of Maine-based health systems, in response to the continued disruption of MaineCare’s pharmacy claims due to the national cyber security issue with Change Healthcare. The amount of the interim payment for these Maine health system-based pharmacies will equal 75% of the average weekly MaineCare reimbursement to each qualifying pharmacy before the disruption. The payments already in place for independent and safety net pharmacies will continue to equal 100% of the average weekly MaineCare reimbursement amount from before the disruption, as these pharmacies are more dependent on MaineCare pharmacy revenue to continue ongoing operations.

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

Michael Silber2024-03-21T12:06:57-04:00March 21, 2024|Maine|

Maryland

Pharmacy reached an important milestone in our effort to make PREP Act immunization authority permanent as our companion bills, SB 18 and HB 76, both passed their respective chambers of origin last week. We are cautiously optimistic that the bills will pass in the opposite chamber prior to sine die.

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

Michael Silber2024-03-21T12:06:10-04:00March 21, 2024|Maryland|

New York

On March 19, the State Department of Health Commissioner signed a standing order regarding the new law authorizing pharmacist dispensing of hormonal contraception. The standing order signed by the State Health Commissioner pertains to three types of self-administered hormonal contraceptives that are approved by the federal Food and Drug Administration to prevent pregnancy, which include the following:

Oral hormonal pill
Hormonal vaginal ring
Hormonal contraceptive patch

Pharmacists who choose to participate can dispense up to 12 months of a self-administered hormonal contraception of the individual’s preference and covered under insurance.

Also in New York, the Office of Health Insurance Programs of the State Department of Health has approved the release of the February 2024 Medicaid Update. The update includes:

Pharmacy:

Policy and Billing:

Update for Long-Term Care Pharmacy Providers on Short Cycle Billing of Pharmacy Claims

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

Michael Silber2024-03-21T12:05:39-04:00March 21, 2024|New York|

South Dakota

On March 5, Gov. Kristi Noem (R) signed HB 1147, legislation addressing discriminatory acts against entities participating in a 340B drug pricing program.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

Michael Silber2024-03-21T12:04:51-04:00March 21, 2024|South Dakota|

Tennessee

TennCare recently released its latest Provider Notice listing changes to the TennCare Pharmacy Program and PDL (Preferred Drug List), effective March 1. Additionally, TennCare launched a newsletter containing up to date TennCare pharmacy information and details from the Pharmacy Provider Notices. Those interested may subscribe.

Also in Tennessee, false prescriptions are being called into pharmacies under Francisco J. Soto, MD, MS, FCCP, who sees patients at University Pulmonary & Critical Care. The phone number used to call in these fraudulent prescriptions may appear to come from a UTMC (University of Tennessee Medical Center) phone number. Pharmacies are advised to contact Renae Gibson at Dr. Soto’s office at 865-524-7471 with any questions regarding his prescriptions.

Finally 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). For details, please see a list 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.

Michael Silber2024-03-21T12:04:19-04:00March 21, 2024|Tennessee|

Texas

The Prescription Monitoring Program’s (PMP) Advisory Committee is meeting remotely on March 28. The meeting materials and agenda will be posted, when available.

Also in Texas, the Health and Human Services Commission (HHSC) provided an update to the Clinical Prior Authorization Assistance Chart, identifying which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.

Finally in Texas, the Health and Human Services Commission (HHSC) selected Gainwell Technologies as the pharmacy benefit administrator for the Vendor Drug Program. Gainwell will continue to use the National Council for Prescription Drug Programs (NCPDP) standard D.0 telecommunication standard format for pharmacy claim transactions beginning on March 30.

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

Michael Silber2024-03-21T12:03:51-04:00March 21, 2024|Texas|

Utah

On March 13, Gov. Spencer Cox (R) signed SB 207, legislation that prohibits the use of extrapolation in pharmacy audits among various other provisions to update the Pharmacy Practice Act.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

Michael Silber2024-03-21T12:03:11-04:00March 21, 2024|Utah|

Washington

The Pharmacy Quality Assurance Commission (PQAC) will hold a rules workshop during the May 2-3 business meeting on draft rule language regarding prescription transfers. The draft rule language discussed at the March 7 meeting was amended (WAC 246-945-345) to clarify noncontrolled prescription transfers, and language was added (WAC 246-945-346) relating to controlled substance prescription transfers. The PQAC is soliciting written comments on the draft rule language through April 5. Submit comments to PharmacyRules@doh.wa.gov; oral comments may be provided at the May rules workshop.

Also in Washington, the Health Care Authority (HCA) hosted a Prescription Drug Affordability Board (PDAB) meeting on March 20. More information about the PDAB is available on the website.

Finally in Washington, the 2024 Regular Session adjourned sine die on March 7. Our #1 priority bill in the state, a PBM reform bill filed by Sen. Patty Kurderer (D), ESSSB 5213, passed both houses and was delivered to Gov. Jay Inslee (D). Although the bill exempts ERISA plans, it enhances the Insurance Commissioner’s enforcement authority, establishes an appeals process, opens the network, includes anti-steering and mail order provisions, prohibits spread pricing, and expands MAC appeals to all prescriptions, not just generic drugs.

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

Michael Silber2024-03-21T12:02:46-04:00March 21, 2024|Washington|

Alaska

PBM (Pharmacy Benefit Management) reform bills NACDS supports continued to advance this week. SB 121 was heard in the Senate Labor and Commerce Committee and HB 226 was heard in House Labor and Commerce on Committee.

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

Michael Silber2024-03-08T11:38:37-05:00March 8, 2024|Alaska|