California
The Department of Health Care Services posted the following alerts and weekly report on the Medi-Cal Rx Web Portal.
- Reminder: State Fiscal Year Two-Week Fee-for-Service Hold for Specific Provider Payments
- Medi-Cal Rx Weekly Wrap-up for May 17-23
- Updates to Continuous Glucose Monitoring and Disposable Insulin Delivery Devices Quantity Limits, Effective June 7, 2024
Also in California, on May 28, the article titled "Change Healthcare Cybersecurity Issue Update" was posted to the Medi-Cal News area on the Medi-Cal Provider website.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
CO24-209, practice act expansion, passed both houses and was sent to Gov. Jared Polis (D) to sign into law.
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. 2589-MC-FFS-D “Discover IA SAIL: Planning for and Addressing Aging Issues Across the Lifespan”.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
HB 579, the PEP/PrEP bill supported by pharmacies, passed both houses and will soon be sent to Gov. Jeff Landry (R) to be signed into law. The Legislature is scheduled to adjourn by 6:00 pm on June 3.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Massachusetts
On May 23, the Senate passed its version of the Fiscal Year 2025 budget. The budget bill will now advance to a legislative conference to work out differences before the end of the fiscal year, June 30, 2024. The relevant issue to pharmacies is language included in the House, but not in the Senate, that would authorize a registered pharmacist to administer a prescription for testosterone for gender-affirming care and for the treatment and prevention of sexually transmitted infections including the prevention of HIV infections. The administration of these therapies shall be in accordance with regulations promulgated by the Department of Public Health in consultation with the Board of Pharmacy and the Department of Mental Health. This proposed change amends the current law which authorizes pharmacists to administer drugs for the treatment of mental health and substance abuse disorders. NACDS will continue to monitor the budget process.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Mississippi
On July 1, the 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. 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.
Montana
On June 17, the Department of Public Health and Human Services will hold a public hearing via remote conferencing to consider proposed amendments to Medicaid and non-Medicaid provider rates, fee schedules and effective dates. For pharmacy providers, the following are proposed changes to outpatient drugs reimbursement for both dispensing fees and vaccine administration fees.
(f) The outpatient drugs reimbursement dispensing fees range as provided in ARM 37.86.1105(3)(b) is effective July 1, 2023 July 1, 2024:
(i) for pharmacies with prescription volume between 0 and 39,999, the minimum is $5.11 $5.28, and the maximum is $16.36 $17.01;
(ii) for pharmacies with prescription volume between 40,000 and 69,999, the minimum is $5.11 $5.28, and the maximum is $14.16 $14.73; or
(iii) for pharmacies with prescription volume greater than or equal to 70,000, the minimum is $5.11 $5.28, and the maximum is $11.98 $12.46.
(g) remains the same.
(h) The outpatient drugs reimbursement vaccine administration fee, as provided in ARM 37.86.1105(6), will be $21.32 for the first vaccine and $18.65 $15.53 for each additional vaccine administered on the same date of service, effective July 1, 2023 July 1, 2024.
Concerned persons may submit their data, views or arguments either orally or in writing at the hearing. Written data, views or arguments may also be submitted to: Bailey Yuhas, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail hhsadminrules@mt.gov, and must be received no later than 5:00 pm on June 21.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Board of Pharmacy held a Workshop meeting this week on proposed draft rules establishing minimum staffing requirements. The Retail Association of Nevada (RAN) and our chain members’ comments emphasized that pharmacies should be able to determine the optimal number of pharmacists and technicians to use in their practice setting. We shared data that the number of prescriptions continues to grow coupled with the continued pharmacist shortage and that the Board should focus on solutions that enhance patient access to pharmacies by adopting rules expanding use of pharmacy technicians and technology. After hearing the testimony, the Board voted in favor of pursuing rulemaking.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the Medicaid Pharmacy Benefit Program, announced updates to the Preferred Drug List. These changes were effective May 29.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Oklahoma
SB 232, legislation that will allow 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, was sent to a House/Senate conference committee on May 28 to work out the differences. The Legislature is scheduled to adjourn its regular session by 5:00 pm on May 31.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy posted the May 2024 newsletter with updates on the 2024 legislative session and rulemaking.
Also in Oregon, Emma Sandoe, PhD, MPH, has been appointed as the permanent director of Oregon's Medicaid program, effective July 24. Since 2019, Dr. Sandoe has served in North Carolina's Medicaid program most recently as the Deputy Director of Medicaid Policy.
Finally in Oregon, the Board of Pharmacy is seeking licensed pharmacists, physicians and advanced practice registered nurses to serve as subject matter experts (SMEs) for the Public Health & Pharmacy Formulary Advisory Committee. The board utilizes SMEs to develop and revise protocols in the Protocol Compendium per OAR 855-115-0345. SMEs will be selected using an application process to ensure representation of diverse practice settings. If you would like to serve as a SME for the PHPFAC, please complete the online form by June 5; scroll down the webpage to access the online volunteer form. Individuals selected will receive confirmation by June 21. Note: Current SMEs, please complete and submit the form so that the board has your current contact information.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
South Carolina
The Department of Health and Human Services (SCDHHS) will cover, for a limited time, imported benzathine benzylpenicillin (Extencilline) for use in outpatient medical drug claims when billed with HCPCS code J0561 and at an outpatient pharmacy (point-of-sale). This policy change to provide temporary coverage is to address the ongoing shortage of Bicillin® L-A (penicillin G benzathine injectable suspension). A letter with important prescribing information for Extencilline has been provided to healthcare providers.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
Despite strong opposition from employer groups and insurance brokers speaking out against any PBM enforcement, new proposed rules by the Department of Commerce and Insurance which will enact Public Chapter 998 and allow Tennessee Department of Commerce and Insurance to audit PBMs were approved by the Government Operations joint committee and will take effect on June 25, 2024. Thank you to Tennessee Pharmacy Association (TPA) CEO Anthony Pudlo, who testified before the Joint Government Operations Committee in support of these rules.
Also in Tennessee, if you would you like to serve on TPA's new Specialty Pharmacy Committee, please complete this form to express your interest. The Committee Chair will make committee appointments in the coming weeks, so please respond soon.
Finally in Tennessee, TPA is looking for Champion Advocates across the state to build relationships with their elected officials and help identify physicians who may advocate for the pharmacy profession. Sign up to become a TPA Champion Advocate!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
On May 28, Texans returned to the polls for runoff elections to decide which Democratic and Republican nominees will be on the November ballot as several races failed to receive more than 50% of the vote in the primary election in March. There were eight US Congressional races, one of which is too close to call with only an 8-vote difference between the two Republican candidates vying for CD 35. In the State Senate, there were two open seats due to one retirement and one running for another office. The State House of Representatives will look much different in 2025, with nine incumbents losing in the March primaries, and seven more incumbents losing their runoffs on May 28. Of the eight Republican incumbents forced into a runoff, only Speaker Dade Phelan (R) and Dr. Gary VanDeaver (R) won their races. The chair of the House Public Health Committee and good friend of pharmacy, Stephanie Klick (R), lost her race.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
Gov. Katie Hobbs (D) issued Executive Order 2024-03 “Protecting Reproductive Freedom Through Increased Access to Contraception.”
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
This week, SB 966 (Wiener) passed the Senate floor with a vote 39-0-1. SB 966 includes provisions that would prohibit the use of “spread pricing”. The bill would also provide other vital reforms, including requiring 100% pass-through of manufacturer rebates to plan sponsors to keep patient premiums low, prohibiting the steering of patients to PBM-affiliated pharmacies and requiring PBMs to obtain a license to operate in the state.
Also in California, SB 1365, legislation increasing the pharmacist to pharmacy technician to 1:4, was placed on the suspense file by the Senate Appropriations Committee and, subsequently, held in committee.
Also in California, the Department of Health Care Services posted the following alert and weekly report on the Medi-Cal Rx Web Portal.
Also in California, as a reminder, this will be the final opportunity to attest for the upcoming fiscal year 2024-2025. For details, review “Pharmacy Provider Dispensing Fee Self-Attestation”. All attestations must be received by May 31 to be accepted. Attestations will not be accepted after closing on May 31; there are no exceptions.
Also in California, the Medi-Cal Rx Diagnosis Crosswalk Navigation, video and the Medi-Cal Rx Reinstatement – Implementation of Reject Code 80 video have been published.
Finally in California, the Department of Health Care Services posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
Gov. Ron DeSantis (R) signed HB 7072, the Tax Package for Fiscal Year 2024-25. The package provides $1.07 billion dollars in tax relief and includes several sales tax holidays that provide Floridians with substantial sales tax relief.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Iowa
As a reminder, the cost of dispensing survey was to be mailed to pharmacies on May 22 and the deadline to respond is July 31. For details, see the Department of Health and Human Services, Iowa Medicaid’s INFORMATIONAL LETTER NO. 2584-MC-FFS Pharmacy Cost of Dispensing Survey 2024.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
The Senate passed HB 579, the PEP/PrEP bill, as amended by a vote of 38-0. The bill now goes back to the House to concur with the Senate amendments.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The Board of Pharmacy posted the agenda for its next scheduled meeting on June 6.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
At its May 20 meeting, the Prescription Drug Affordability Board selected six prescriptions drugs for cost review studies.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Department of Health (MDH) recently released the Minnesota Prescription Drug Transparency: 2024 Report to the Minnesota Legislature (PDF). The report presents analysis of information reported to MDH through June 2023, provides a summary and timeline for the implementation of new work and assesses the Prescription Drug Price Transparency Act’s (the Act) progress toward statutory goals. Key findings from this report include:
- There is notable interest in public data on drug prices, including from health care payers in Minnesota. In 2023, MDH saw more than 6,500 visits to its web pages dedicated to prescription drug price transparency.
- Price increases of reportable drugs affect many Minnesotans. More than 75,000 people living in the state used these drugs in 2022. Collectively, the increases contributed to additional health care spending of more than $53.2 million in 2022.
- Overall, many pricing trends are in line with previous reports. However, one notable departure is that data show prices for new drug introductions increased significantly with many new drug products priced over $3 million.
- Among the most expensive drugs reported, the prices for these drugs in Minnesota were higher than prices for the same drugs internationally.
- Many drug manufacturers continue to be out of compliance with the full requirements of the Act. Approximately 33% of reports have not been submitted (99 distinct manufacturers are delinquent for 775 total reports), and all reports have data quality issues upon initial submission.
MDH will continue to release updates on implementation on the MDH Rx Price Transparency website. For questions, please email health.rx@state.mn.us.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Montana
The Department of Labor and Industry is looking for a pharmacist to serve in a new third inspector position for the Board of Pharmacy. This position is responsible for performing pharmacy inspections around the state, issuing inspection reports, verifying licensure of pharmacy personnel and facilities, verifying compliance with state and federal statutes and regulations, and communicating with a variety of licensees and stakeholders. The application closing date is May 30. The job posting and instructions for applying are available online. If you have any questions, please contact Marcie Bough, Executive Officer, at (406) 841-2371.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nebraska
The Department of Health and Human Services posted the Drug Utilization Review (DUR) Board draft meeting minutes from May 7.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New York
On May 21, the Senate Committee on Higher Education reported favorably S9186, a bill to update shared pharmacy services. The bill will establish conditions under which resident or non-resident pharmacists and pharmacies may participate in shared pharmacy services. S9186 has previously passed the Assembly. NACDS will continue to advocate for final passage of the bill in the Senate.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.