This week, HB 596, related to PBM reform, was reported out of the House Health and Welfare Committee with a “Do Pass Recommendation”. This legislation would add new definitions; outline requirements that make contracts with pharmacies transparent and fair; require PBMs (Pharmacy Benefit Managers) to provide transparent pricing on drugs and require PBMs to report to the Department of Insurance in a transparent way.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
The Health Coverage Programs (IHCP) issued Bulletin 202419 on adjustments and reprocessing claims for COVID-19 vaccines and administration codes.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
On February 26, HF 555 passed the Senate with a unanimous vote (46-0). It returns to the House for concurrence with the Senate amendments.
Also in Iowa, the Department of Health and Human Services, Iowa Medicaid posted the following:
Finally in Iowa, the Board of Pharmacy adopted and filed ARC 7617C to amend Chapter 10, “Controlled Substances”. The amendment temporarily places five substances (novel psychoactive substances of the benzodiazepine class, also known as “designer benzodiazepines”) to Schedule I of the Iowa CSA (Controlled Substances Act) in response to similar action taken by the federal Drug Enforcement Administration. The amendment is effective March 13.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
MedImpact issued a communication to pharmacies regarding reprocessing managed care claims for Lagevrio. Prescriptions dispensed using the commercially distributed product for Managed Care members prior to February 8, 2024, may be reversed and reprocessed to include the ingredient cost in the final paid amount. They will automatically reprocess claims that pharmacies have not resubmitted within the next 60 days. This does not apply to fee-for-service claims.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Medicaid issued a Pharmacy Facts program update alerting pharmacies that the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCO) Magellan, will contact network Pharmacy Services Administrative Organizations (PSAO), chains and independent pharmacies, to agree to the new level of effort (LOE) compound fee schedule effective April 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
On February 27, MaineCare announced it is now authorizing 30-day prescriptions to continue to assist pharmacies in fulfilling MaineCare member prescriptions in response to the Change Healthcare network interruption. This is a change from MaineCare’s temporary authorization of the use of a three-day override as noted in its February 23 e-message.
The Department will pay all eligible claims submitted once the system is operational. It is working on the details for when and how such payments will be made and will release the details as soon as possible. Change Healthcare has not issued a timeline for resolution yet. The Department will communicate a timeline for resuming normal payments as soon as possible.
Pharmacies should continue to process claims as usual. Pharmacies should check eligibility for MaineCare members during this period by calling MaineCare Provider Services at 1-866-690-5585 or checking the HealthPas online portal.
We are continuing to waive all prior authorization (PA) mandates for pharmacy. With this change to authorize 30-day prescriptions, we expect pharmacies to return to following the MaineCare Preferred Drug List (PDL).
Consistent with state and federal requirements, pharmacies may not bill, demand, or otherwise seek payment from MaineCare members (or a representative of the member) for any MaineCare covered service.
The Department stands ready to assist pharmacies in assessing MaineCare eligibility and facilitating coverage during this extraordinary period and thanks pharmacies and their staff for their help in ensuring access to medications for MaineCare members.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
The Massachusetts Joint Legislative Committee on Financial Services has reported H4066, a bill to expand pharmacist’s scope of practice, favorably out of the committee. Specifically, the bill directs the Board of Pharmacy to establish protocols for pharmacies to test, screen and initiate treatment or therapy for qualified health conditions: Influenza, Streptococcal infections, COVID-19, HIV, and any other conditions approved by the Board. H4066 also allows pharmacists to delegate the tasks of performing a CLIA–waived test to pharmacy technicians acting under the supervision of the pharmacists. Lastly, the bill requires insurance carriers to make available provider and consult codes for pharmacy compensation which shall be at the standard contracted rate that they reimburse for the same services by any other healthcare provider. H4066 will now be assigned to a committee of second jurisdiction. NACDS will continue to partner with the Massachusetts Chain Pharmacy Council to advocate for final passage of the bill.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
On March 4, the House Health and Mental Health Committee will hold a hearing on HB 1627, legislation pharmacies support that would bring some much-needed PBM reforms. The Missouri Pharmacy Association is organizing a rally at the Capitol on Monday, urging pharmacists and technicians to show up at 11:00 am to tell legislators that “Enough is enough” with PBM abuses.
Also in Missouri, the Board of Pharmacy’s February 2024 newsletter was posted on the Board’s website.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Board of Pharmacy posted a revised agenda for its March 4 meeting. The board also posted the draft minutes from the January 8 and the February 6 meetings.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.