Kentucky
MedImpact, the Commonwealth’s Single PBM, issued a Preferred Drug List update (PDL update) regarding coverage of Humulin N and Novolin N vials.
Also in Kentucky, Medicaid should now be reimbursing pharmacies both an ingredient cost and an administration fee for vaccines provided to children even if the pharmacy is not enrolled in the Vaccines for Children program. Also, due to the passage of HB 274, effective July 15, 2024, pharmacies will be authorized to administer the full range of vaccines starting at age five years (currently age nine years) under a prescriber-approved protocol. If you are experiencing any issues with vaccine reimbursement from Medicaid Fee-for-Service (FFS) or Managed Care, please contact NACDS’ Jill McCormack.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Gov. Jeff Landy (R) signed into law the PEP/PrEP bill, HB 579, sponsored by Rep. Wayne McMahen (R), that will improve critical community access to HIV prevention services. With one of the highest rates of HIV in the country, the Department of Health (LDH) recognized the need for better access. LDH worked with the Louisiana Alliance for Retail Pharmacies (LARP) and other groups advocating for expanding options for at-risk patients to receive timely, convenient and lifesaving care at their local neighborhood pharmacies.
Also in Louisiana, Gov. Landry (R) announced key leadership changes. The Department of Health Secretary (LDH) Dr. Ralph Abraham transitions to the newly created Surgeon General role, Undersecretary Michael Harrington was named as the new LDH Secretary and Chief of Staff Drew Maranto was promoted to Undersecretary of LDH. The Secretary of LDH is responsible for implementing the Surgeon General’s recommendations, overseeing fiscal matters and ensuring the operations of the Department are carried out efficiently and effectively. Both the Secretary and the Surgeon General report directly to the Governor.
Also in Louisiana, LDH announced that Myers and Stauffer will be conducting a pharmacy cost of dispensing survey in August 2024 to evaluate the Medicaid pharmacy reimbursement methodology. A Zoom stakeholder meeting will be held at 9:00 am on July 15. LDH and Myers and Stauffer representatives will discuss the scope of the survey, timeline for completion and address stakeholder questions about the process.
Finally in Louisiana, Medicaid is implementing changes to the Single Preferred Drug List (PDL) on July 1, 2024. The current PDL indicated a preference of some brand name drugs over generic drugs. The revised PDL will shift both brand and generic versions of these drugs to preferred status. The new PDL will be posted online.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The Prescription Drug Affordability Board (PDAB) has selected 6 drugs they propose to subject to a cost review process. If members wish to submit comments on any or all the choices, please send them to comments.pdab@maryland.gov with the subject line: Board Selected Drugs (Drug Name) by July 22. For more information on the PDAB or on the comment process, see the PDAB’s Board Selected Drugs Page.
Also in Maryland, Medicaid Fee-For-Service released Advisory #263 in reference to the Generic vs. Brand Status on Medicaid’s Preferred Drug List (PDL) effective July 1, 2024.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
On June 25, MassHealth published its regular pharmacy facts update that includes revisions to the MassHealth Drug List.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
The Department of Health’s Rx Transparency team recently sent an email to pharmacies and other reporting entities providing further instructions for filing prescription drug pricing information that will be required later this year under law. Additionally, the email reminded pharmacies licensed in Minnesota that they are required to register an account with the Department of Health’s (MDH) Online Reporting Portal and report on the Public Interest Drug lists, stating that “pharmacies that have not yet registered should do so promptly and may use our Registration Quick-Start Guide (PDF) to get started.” For more information, visit: MN Rx Transparency Home Page, Information for Reporting Entities and Public Interest Drug Lists.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Mississippi
On July 1, the Mississippi Division of Medicaid (DOM) will implement a single Pharmacy Benefit Administrator (PBA) to streamline and enhance the processing and management of pharmacy claims for all Medicaid members, including those enrolled in MississippiCAN and CHIP.
Operated by Gainwell Technologies, the PBA will also assume all pharmacy prior authorization responsibilities for drugs submitted on pharmacy claims. DOM will continue to require the use of the Universal Preferred Drug List (PDL). This decision comes after careful consideration and evaluation of various factors aimed at enhancing efficiency and transparency in the Medicaid delivery system.
Medicaid members should notice no disruption in their care if providers are prepared for this change.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Missouri
NACDS sent a letter to Gov. Mike Parson (R) urging him to sign SB 751, legislation expanding the opportunity for pharmacies to participate in the 340B drug program. The bill also prohibits pharmaceutical manufacturers from restricting where patients can access their 340B medications, a restriction not in place before the pandemic. The Governor has until July 14 to act on the bill.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services announced the launch of a new feature on the State Immunization Information System (NESIIS). Beginning June 10, 2024, Nebraskans have the option to securely download their personal (or their child’s) immunization information from NESIIS to their Android or iOS mobile device. This enables the option to share immunization records from NESIIS quickly and easily with healthcare providers, schools or other organizations.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
The State Department of Health released a notice of reminders to pharmacy providers in case of severe weather events. These include drug storage, vaccines for children, drug delivery and NYRx prior authorizations.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Nevada
The Board of Pharmacy is holding a public hearing on July 18 in Reno. The full meeting agenda has not been posted.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Ohio
Ohio will soon join the ranks of states that have updated its immunization law post-pandemic. On June 26, the last day of session prior to summer recess, the House passed, and the Senate concurred on SB 144. The bill will permit pharmacists and technicians to administer a vaccine “for any disease” to patients aged five years and older. It is now on its way to Gov. Mike DeWine (R) for signing. NACDS thanks our in-state partners, members and allies for the remarkable team effort in getting this bill across the finish line.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Effective July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) will implement a single, state-directed pharmacy benefit preferred drug list (PDL) for all members and providers enrolled in the South Carolina Healthy Connections Medicaid program; see MB #24-016 for details.
SCDHHS recently held live training webinars to answer questions from providers about the upcoming transition to a single PDL. The training sessions were intended for prescribers and dispensers. A recording is available on SCDHHS’ website for those who were unable to attend either training webinar. A frequently asked questions document, which is available in the pharmacy section of SCDHHS’ website, has also been updated.
The single PDL is based on SCDHHS’ current fee-for-service (FFS) PDL. The current FFS PDL is available in the pharmacy section of SCDHHS’ website.
As a reminder, South Carolina’s Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in MB #24-016 for Healthy Connections Medicaid members who are enrolled in an MCO.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The TennCare pharmacy diaper program will launch on August 1, 2024. For children ages two years and younger, the program provides access to up to 100 diapers per month per child. Children with TennCare or CoverKids are eligible. Pharmacies can voluntarily participate as access points for the program; an informational webinar for pharmacies will be held on July 9 from 9:00-10:00 am CT.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) will update the Medicaid Preferred Drug List (PDL) on July 25. HHSC is making changes to the PDL based on recommendations agreed to at the January and April Drug Utilization Review (DUR) Board meetings. The April 26, Preferred Drug List recommendations and January 26 Preferred Drug List decisions are available for review.
Also in Texas, in advance of the July 1, 2024 deadline, NACDS submitted comments to the HHSC VDP in support of the draft policy change expanding the list of vaccines included on the Medicaid formulary. Importantly, adopting this updated policy would expand access to a broader portfolio of pharmacy provided vaccines for adults covered under the Medicaid program. NACDS also urged VDP to adjust the Medicaid pharmacy vaccine administration fee to align more closely with the administration fee that CMS has set for pharmacy-provided vaccines covered by Medicare.
Finally in Texas, the Prescription Monitoring Program (PMP) Advisory Committee met on June 27. The PMP Advisory Committee recommends to the Board of Pharmacy operational improvements, identifies data concerns and suggests methods to improve data accuracy, integrity and security.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Committee (PQAC) held a one-day meeting on June 27.
Also in Washington, starting in July, Apple Health coverage is expanding to adults age 19 years and older with certain immigration status.
Finally in Washington, the Health Care Authority (HCA) published quarterly updates to many of the Apple Health billing guides that go into effect on July 1, 2024. Billing guides are located on HCA’s Provider billing guides and fee schedules webpage.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Servies posted the following alerts and weekly notice on the Medi-Cal Rx Web Portal.
- Mass Adjustment for Enteral Nutrition for Impacted Claims Submitted December 27, 2022, through March 13, 2023
- Mass Adjustment for Blood Factors for Impacted Claims Submitted January 1, 2022, through October 25, 2022
- Mass Adjustment for Diabetic Lancets for Impacted Claims with a Date of Service January 1, 2022, through December 31, 2022
- Mass Adjustment for Disposable Insulin Delivery Devices for Impacted Claims Submitted April 1, 2022, through April 28, 2022
- Code I Diagnosis Requirement for Chronic Weight Management
- Medi-Cal Rx Weekly Wrap-up for June 7-13
Also in California, the Department of Health Care Services posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
The Family and Social Services Administration's (FSSA) Health Coverage Programs (IHCP) issued BT202476 to update providers on Health Indiana Plan (HIP) preventive care services exempt from copayment.
Also in Indiana, the Health Coverage Programs (IHCP) issued a bulletin reminding providers about the Fee-for-Service (FFS) prior authorization appeals process.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
The Board of Pharmacy is meeting at 8:30 am on July 11 in Topeka via Teams; view the meeting's webpage for a list of proposed rules and instructions on how to join the meeting in Teams. At 1:00 pm, the Board will be discussing the new proposed telepharmacy regulations.
Also in Kansas, Gov. Laura Kelly (D) convened a special session on June 18 to address taxes. The session was necessary because she vetoed the legislature's tax bill.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
Gov. Jeff Landy (R) signed into law SB 281 – ACT 514, legislation pharmacies supported that will enhance the Attorney General’s enforcement authority over PBM audits, effective August 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
NACDS will be joining the Massachusetts Chain Pharmacy Council and other members of the Patients Not PBMs coalition in support of PBM reform legislation at the Massachusetts State House on Wednesday, June 26, 2024, at 11:00am. The event will include speakers from the pharmacy and patient communities. NACDS encourages members to send as many pharmacists and associates as possible.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
Medicaid Bulletin MMP 24-19 was issued on May 31 to announce updates to the Medicaid Provider Manual.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Department of Social Services MO HealthNet (Medicaid) Pharmacy Preferred Drug List (PDL) and Utilization Management Edits updates are available online.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Department of Health issued protocols to increase access at pharmacies for Medicaid patients to over-the-counter (OTC) emergency contraception, the OTC progestin-only birth control pill and the OTC home pregnancy tests.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
On July 1, 2024, Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans (or "Tailored Plans") are a new kind of Medicaid Managed Care health plan. Tailored Plans cover doctor visits, prescription drugs and services for mental health, substance use, intellectual/developmental disabilities and traumatic brain injury in one plan. Tailored plans will launch statewide starting July 1, 2024. Approximately 200,000 beneficiaries will be enrolled into Tailored Plans. For more detailed information, please review the Fact Sheet: What Providers Need to Know Before Tailored Plan Launch.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The House Health Committee advanced SB 144, a priority bill for members. The legislation will more closely align the existing pharmacy immunization law with the PREP Act. Specifically, the bill permits pharmacists, interns and technicians to administer any vaccine to patients aged 5 years and older. We expect the House and the Senate to give final approval to the bill next week. If all goes as planned, it should be on the Governor’s desk before summer recess. The bill will be effective 90 days after it is signed.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.