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.
Michigan
Pharmacy Controlled Substance Administrative Rules have been revised and changes are effective as of May 31, 2024. One amendment of note is the removal of Gabapentin, meaning it is no longer classified as a controlled substance in the state. A prescriber without a controlled substance license can now prescribe Gabapentin, and Gabapentin no longer needs to be included in reporting to the Michigan Automated Prescription System (MAPS).
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
The Department of Social Services, MO HealthNet Division (MHD), reminded covered entities to comply with all the Health Resources and Services Administration (HRSA) 340B Program rules, including the exclusion of using 340B stock for inpatient administration and the prohibition of duplicate discounts.
Also in Missouri, to raise awareness about Project Hep Cure, Josh Moore, the Director of Pharmacy at MO HealthNet, sent a message to healthcare providers on how to help cure Missourians of the disease.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oklahoma
The legislature adjourned sine die on May 30.
SB 232, legislation allowing pharmacists to screen and treat for minor ailments and other conditions, dispense hormonal contraceptives without a prescription and increase the pharmacy technician ratio from two to three, died due to the early adjournment of the legislature.
Two PBM reform bills that pharmacies supported because they enhanced the Attorney General's enforcement authority, addressed MAC pricing and audits, were enacted into law. SB 1670 / HB 3376
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy will meet on June 12-14. The agenda and meeting materials are available online.
Also in Oregon, the following individuals have been appointed to the Board of Pharmacy: Amy Kirkbride with Kaiser Permanente, Victoria Kroeger with Walgreens and Ana Pinedo.
Finally in Oregon, the Division of Financial Regulation announced this proposed rulemaking. These proposed rules implement 2023 Oregon Enrolled SB 797, Oregon Laws 2023, chapter 113, which requires certain health insurance policies to provide coverage for prosthetic and orthotic devise as defined in the bill.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please see the June 2024 Provider Update from Medicaid. All previous provider updates are available online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS' contracted vendors. Information about the upcoming June-August 2024 training is listed below.
Medicaid eLearning Provider Workshops
SCDHHS' contracted vendor provides web-based training, presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.
To register for a workshop or find additional training resources, please visit www.medicaidelearning.com or call the Provider Service Center (PSC) at (888) 289-0709. The PSC's hours of operation are 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday.
Also in South Carolina, with the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) is required to resume the provider revalidation process. SCDHHS will restart this process in June 2024.
In order to revalidate or renew the provider enrollment record with the state Medicaid agency, an enrollment revalidation application must be submitted. The provider revalidation process is designed to confirm or update a provider's demographic and other information including National Provider Identifier, mailing address and service location address(es). There are no exemptions from revalidation.
Consistent with federal regulations (42 CFR §455.414), state Medicaid agencies must complete revalidation of enrollment for all providers, regardless of provider type, at least every five years. However, provider types designated by either CMS or SCDHHS as "high-risk" providers are required to revalidate every three years. High-risk providers include durable medical equipment (DME), home health agencies, targeted case management, rehabilitative behavioral health services and licensed independent practitioner rehabilitative services. High-risk providers may also require a physical site visit or fingerprint-based criminal background check (FCBC). For more information on high-risk providers, please review the Provider Enrollment and Screening Requirements FAQs.
Impacted providers will receive an official revalidation notification letter in the mail. The notification contains a unique revalidation number necessary to begin and complete the revalidation process. To avoid risk of termination from the Healthy Connections Medicaid program, providers must complete the revalidation process. The first step in the revalidation process is completing the online enrollment revalidation application within 30 days. Providers will be notified when the cohort window is open for their specific provider type to begin the process. Providers must not attempt to begin the revalidation process until they have received notification.
Provider revalidation for cohort one begins June 17, 2024. The revalidation window for cohort two and future cohorts will be announced in subsequent provider bulletins that will be published approximately 30 days prior to the start of the respective revalidation windows.
A list of providers scheduled for revalidation will be published on the SCDHHS' website as each cohort's revalidation period begins.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
This notice is being sent to inform you of changes to the TennCare Pharmacy Program. We encourage you to read this thoroughly and contact OptumRx’s Pharmacy Support Center (866-434-5520) should you have additional questions.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Prescription Monitoring Program's (PMP) Advisory Committee will meet via Zoom on June 27.
Also in Texas, the Health and Human Services Commission's (HHSC) Vendor Drug Program (VDP) is hosting a Hepatitis C educational webinar on June 13.
Finally in Texas, the Texas Pharmaceutical Initiative (TPI) Board's next meeting will be held on June 11 at 10:00 am.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Vermont
As the Department of Vermont Health Access (DVHA) has previously reported, Change Healthcare (CHC), which operates Vermont's Medicaid pharmacy claims system, experienced a significant cybersecurity issue on February 21. The cybersecurity incident impacted enrolled pharmacy providers' ability to process and submit claims for Medicaid services. In response to the outage, Vermont Medicaid is temporarily increasing the Professional Dispensing Fee for retail pharmacies.
Vermont Medicaid will provide an enhanced Professional Dispensing Fee for prescribed drugs to account for the manual and time-consuming procedures pharmacies had to perform due to the Change Healthcare outage. The Professional Dispensing Fee for pharmacy claims of $11.13 will increase by $3.26 per claim to $14.39, from June 3, 2024, to June 30, 2024. This change will be automatically implemented for pharmacy claims, excluding specialty drug and 340B drug claims. Providers are not required to enroll or apply for the enhanced professional dispensing fee. Standard payment of covered outpatient drugs, including over the counter (OTC) drugs, billed to DVHA on a primary basis and dispensed by an enrolled pharmacy is detailed in the Pharmacy Provider Manual. All manuals and rules are available online.
This change is one of several temporary flexibility and changes being made to support providers impacted by the Change Healthcare cybersecurity incident. Additional information on these changes can be found in Global Commitment Register 24-029 Change Healthcare Outage—Medicaid Response. Please contact the Change Healthcare Pharmacy Help Desk with any questions at 1-844-679-5362.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Washington
The Health Care Authority (HCA) will change to a new pharmacy point-of-sale system on June 8. The system will be off from midnight until 3:30 pm on June 8-9. HCA will notify providers once the new system is running and can adjudicate claims. At 5:00 pm on June 6, pharmacy prior authorization faxes will cease being accepted. HCA will start accepting prior authorization faxes again on June 10. HCA’s ProviderOne Point of Sale (POS) Replacement Project provided an updated payer sheet.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
HB 226D, comprehensive legislation pharmacies supported to ensure patient choice of pharmacy, improve transparency and accountability in pharmacy benefit management and enhance the standards for pharmaceutical care across the state, passed the legislature. The bill is awaiting transmittal to Gov. Mike Dunleavy’s (R) office to be signed into law.
For more information, contact NACDS’ Mary Staples at 817-442-1155.