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.
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.