Oklahoma
A coalition of pharmacy groups, including American Pharmacies, Inc., the American Pharmacists Association, the National Community Pharmacists Association, the Oklahoma Pharmacists Association and NACDS, asked the U.S. Supreme Court to once again decide whether states can regulate pharmacy benefit managers after the Tenth Circuit Court of Appeals struck down a lower court that upheld a law passed by Oklahoma in 2019.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
NACDS submitted a letter to the Prescription Drug Affordability Board (PDAB) expressing concern about the inclusion of vaccines in PDAB affordability reviews and strongly encouraging the removal of vaccines as eligible for affordability reviews by the PDAB. Both the Affordable Care Act and the Inflation Reduction Act mandate that all vaccines recommended by CDC's Advisory Committee on Immunization Practices (ACIP) are covered without cost-sharing for all publicly and privately insured individuals.
Also in Oregon, the Prescription Drug Affordability Board (PDAB) posted the agenda and meeting materials for its next meeting on June 26. Please register in advance of the meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
The Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments in June-July 2024. Due to the Independence Day holiday, June 28 is the deadline to submit claims for payment date July 5. Payments will run July 1 and electronic remittance advice will be available on July 4. Payments will be dated July 5, as usual. The schedule will return to the normal payment cycle on payment date July 5, 2024. Please refer any questions or concerns regarding this bulletin to the Provider Service Center (PSC) at (888) 289-0709.
Also in South Carolina, effective July 1, 2024, the Department of Health and Human Services (SCDHHS) is updating and clarifying policies in the Provider Administrative and Billing Manual. These policy changes will be added to the Provider Administrative and Billing Manual available on SCDHHS' website by July 1.
Finally in South Carolina, the Centers for Medicare and Medicaid Services (CMS) has informed the Department of Health and Human Services (SCDHHS) that Healthy Connections Medicaid providers will participate in the Payment Error Rate Measurement (PERM) program for state fiscal year 2025; see MD #24-029 for details. CMS' PERM program was developed to measure the accuracy of Medicaid and Children's Health Insurance Program (CHIP) payments made by states. Each state is reviewed once every three years. Samples of claims with paid dates of July 1, 2024, through June 30, 2025, will be subject to review.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP) Medicaid is soliciting stakeholder comments about adding 14 additional vaccines to be a covered benefit for the Adult Vaccines Program. HHSC already covers influenza and COVID-19 vaccines on the Texas Medicaid formulary and proposes adding the additional vaccines listed above for adults ages 19 years and older enrolled in Medicaid. Comments are due on July 1, 2024, and must be submitted using the HHS Form 1342.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Virginia
The Board of Pharmacy posted the agenda for its June 25 meeting. Please note they intend to discuss the emergency regulations for central fill/remote processing, the final regulations updating the 2022 test and treat law and current pharmacy workforce conditions in preparation for a new workforce survey.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The Pharmacy Quality Assurance Commission (PQAC) is meeting on June 27. Written comments must be submitted by 5:00 pm on June 21 to WSPQAC@doh.wa.gov.
Also in Washington, the Health Care Authority's (HCA) Health Care Cost Transparency Board began collecting data from the largest health insurance carriers in the state in 2022. The first annual report, Health care spending growth in Washington, 2017–2019, and one-page summary of key findings are now available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
The Board of Pharmacy proposed regulation changes dealing with pharmacy technicians, collaborative practice authorities, sterile pharmaceutical guidelines, manufacturer license requirements, PDMP (Prescription Drug Monitoring Program) registration, alternative to probation program and definitions. Written comments should be submitted to RegulationsAndPublicComment@alaska.gov by 4:30 pm on July 8.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
The Legislative Council approved a rule that allows Medicaid reimbursement for continuous blood glucose monitors (CGMs).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Servies posted the following alerts, weekly report and monthly bulletin on the Medi-Cal Rx Web Portal.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
Gov. Jared Polis (D) signed into law a late bill filed by the Colorado Chain Pharmacy Council, SB24-209, expanding the pharmacy practice. The key provisions are eliminating restrictions on telepharmacies, removing the age limit for pharmacists’ prescriptive authority, allowing dispensing through an automated dispensing system, expanding pharmacy technicians’ duties to allow point-of-care testing and administering all immunizations and the ability to request refills and perform other designated tasks.
Also in Colorado, the Colorado Pharmacists Society (CPS) workplace conditions survey is available here.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Delaware
On June 11, the House of Representatives Committee on Economic Development reported favorably SB 272, an act relative to pharmacy provider status. The bill was previously approved by the Senate on May 16. This Act requires health insurers to provide the same reimbursement to pharmacists that is already provided other providers performing the same services at the same rates as advance practice registered nurses and physician assistants. The bill now continues through the legislative process in the House.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Florida
Following the severe weather that impacted South Florida on June 11, Gov. Ron DeSantis (R) issued Executive Order 24-115 (South Florida Flash Flooding) declaring the following counties under a state of emergency: Broward, Collier, Lee, Miami-Dade and Sarasota.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Idaho
The Board of Pharmacy posted its June 2024 newsletter.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
Following several policy victories over the last few years, pharmacy should have a clear runway to increase children’s vaccine rates in the Commonwealth. First, effective June 1, 2024, Medicaid FFS (Fee-For-Service) implemented a new policy to allow pharmacies to bill the program for vaccines. Second, last year Medicaid adopted a final rule that removed the VFC (Vaccines for Children) enrollment requirement. This change allows providers to bill Medicaid for children’s vaccines regardless of VFC participation. Lastly, HB 274 of 2024 was signed into law, lowering the age floor. Effective July 15, 2024, pharmacies will be permitted to administer any vaccine to children 5 years of age and older (lowered from age 9 years).
Also in Kentucky, the Board of Pharmacy issued the following rules for public comment, due to the Board by August 31. They are also scheduled for a public hearing on August 28. If you have comments, please send them to Jill McCormack by August 5.
- 201 KAR 2:210. This amendment re-orders the sections of the regulation and adds sections and definitions regarding the regulation of automated filling systems and final product verification.
- 201 KAR 2:480, Telework and Electronic Supervision for Remote Prescription Processing. New Regulation. Adds KRS 315.020(5) to authorize order entry, order entry verification and drug regimen review as tasks that can be performed outside of the permitted space of the pharmacy. It also provides minimum requirements for pharmacies engaged in remote prescription processing conducted via telework and establishes rules for electronic supervision.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
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.