California
The Department of Health Care Services posted the following alerts, weekly notices and monthly bulletin on the Medi-Cal Rx Web Portal:
- Medi-Cal Rx Weekly Wrap-up for July 26-August 1
- State of Emergency Override Activation: Submission Clarification Code 13
- Medi-Cal Rx Monthly Bulletin for August
- 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 Family Planning, Access, Care and Treatment Pharmacy Formulary
- Updates to the Medi-Cal Rx Provider Manual
- Medi-Cal Rx Weekly Wrap-up for July 19-25
- CalAIM Justice-Involved Reentry Initiative and Medi-Cal Rx
Also in California, this week, SB 966, PBM reform legislation, including provisions prohibiting the use of spread pricing, requiring 100% pass-through of manufacturer rebates to plan sponsors, and prohibiting the steering of patients to PBM-affiliated pharmacies, was placed on the Assembly Appropriations Committee suspense file and must be voted off the suspense file by August 16 to advance to the Assembly floor.
Finally in California, this week, the following bills were placed on the Senate Appropriations Committee suspense file and must be voted off the suspense file by August 16 to advance to the Senate floor:
- AB 1794, legislation clarifying that the value of all property taken over the course of distinct but related acts may be aggregated even though the thefts occurred in different places or from different victims and authorizing counties to operate a program to allow retailers to submit details of alleged shoplifting, organized retail theft or grant theft directly to the county district attorney through an online portal to the district attorney’s internet website.
- AB 82, legislation prohibiting a retail establishment from selling dietary supplements for weight loss or over-the-counter diet pills to any person under 18 years of age without a prescription. Amendments to the introduced language lowered the civil penalties from $1,000 to $250 for each violation and changed the effective date to January 1, 2026.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
On August 19, the Board of Pharmacy is holding a Stakeholder Meeting to receive feedback on proposed changes to the following draft rules:
- Rule 14.00.00 – OTHER OUTLETS – The purpose of the proposed amendments to
Board Rule 14 is to allow off-site dispensing by hospital staff.
- Rule 15.00.00 – WHOLESALERS – The purpose of the proposed amendments to
Board Rule 15 is to update recordkeeping requirements of wholesalers
specifically related to animal drugs.
- Rule 17.00.00 – COLLABORATIVE PHARMACY PRACTICE – The purpose of the
proposed amendments to Board Rule 17 is to update Collaborative Pharmacy
Practice Rules as they relate physician assistants to align them with
superseding regulatory changes around physician assistants.
- Rule 21-00-00 – COMPOUNDING – The purpose of the proposed amendments to
Board Rule 21 is to update controlled substance distribution laws to better
clarify the law and align with federal requirements.
- Rule 17, Appendix A – The purpose of the proposed amendments to Board Rule
17, Appendix A is to update clinical standards and to fix minor clerical errors.
- Rule 3.00.00 – DISPENSING – The purpose of the proposed amendments to Board
Rule 3 is to add a short rule clarifying and referring to the new legislative
requirement of prescription label accessibility from HB24-1115.
- Rule 23.00.00 – ELECTRONIC PRESCRIPTION MONITORING PROGRAM – The
purpose of this Rule Revision is to change the requirement to report pharmacy
data submission delinquency to the Board and give flexibility may changing
“will” to “may” which statute allows.
- Rule 11.00.00 – RECORDS – The purpose of this Rule revision is to update
outdated terminology that no longer exists related to board approval of
electronic record storage.
- Rules 2.00.00 – ORDERS, 3.00.00 -DISPENSING, and 31.00.00 – TELEPHARMACY –
The purpose of the proposed amendments to Board Rule 2, 3, and 31 is to
implement SB24-209 Changes to the Pharmacy Practice Act Regarding
Dispensing of Prescription Drugs, including repeal of Area of Need from
Telepharmacies, updated labeling requirements, and updated functional ability
for technicians.
Also on the Stakeholder Meeting agenda are two new proposed rules:
- Rule 17.00.00, Appendix F – MAT Prescription Protocol – The purpose of the
proposed Rule 17, Appendix F is to create a new MAT Prescribing Statewide
Protocol required as part of implementation of HB24-1045.
- Rule 17.00.00, Appendix E – The purpose of the proposed amendments to Board
Rule 17, Appendix E, is to create a new state-wide protocol of clinical
standards for statin therapy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Florida
For Medicaid recipients, maintaining access to critical Medicaid services is imperative during the State of Emergency related to Tropical Storm Debby. To this end, the Agency will ensure reimbursement for critical Medicaid services provided in good faith to eligible recipients who reside in the counties impacted by the storm. The Agency will waive all prior authorization requirements for critical Medicaid services beginning August 4, 2024, until further notice. Early prescription refill edits have been lifted for all maintenance medications (note: this does not apply to controlled substances).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Family and Social Services Administration’s (FSSA) Indiana Health Coverage Programs (IHCP) Medicaid posted a bulletin with new pharmacy updates approved by the Drug Utilization Review Board July 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
Board of Pharmacy was moved from the Department of Health and Human Services (DHHS) to the Department of Inspections, Appeals and Licensing (DIAL). Upon the transition to DIAL, all health profession programs were combined into one with one set of rules, requiring a common naming convention. The Iowa Monitoring Program for Pharmacy Professionals (IMP3) will now be the Iowa Professional Health Program – Pharmacy (IPHP-Pharmacy). The program’s role is to provide pharmacy professionals and student pharmacists with support for recovery from substance use, mental health issues and other physical conditions.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
The Board of Pharmacy reminded pharmacy technicians that they must pass a national technician certification exam before the first renewal or, if previously registered, at the time of application. The Board approved the Pharmacy Technician Certification Board (PTCB) and the National HealthCareer Association Examination for the Certification of Pharmacy Technicians (ExCPT).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
The Department for Medicaid Services covers items such as wheelchairs, orthotic appliances and disposable medical supplies when ordered by an approved prescriber and are medically necessary. If your pharmacy is enrolled as a Medical Supplies, Equipment and Appliance (MSEA) provider (PT90), you may bill covered nutritional supplements and disposable supplies as a medical benefit under provider type 90. Reimbursement amounts are listed in the Medicaid MSEA Fee Schedule and defined in 907 KAR 1:479. Billing and enrollment instructions are available online. For children under 21 years of age, an item not listed on the MSEA fee schedule may be covered under Early Periodic Screening Diagnosis and Treatment Services (EPSDT) Special Services which requires prior authorization. For assistance, please contact the EPSDT Special Services Coordinator at ivy.sams@ky.gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Council on Medicaid Pharmacy Reimbursement met on July 30 to receive updates from the Department of Health (LDH) on the state’s single PBM, the Medicaid PDL and the Myers and Stauffer dispensing cost survey that will be distributed to pharmacies in early August.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The Maine Board of Pharmacy held its regular scheduled meeting on August 1, 2024. The agenda included proposed rulemaking on:
- Chapter 7: Licensure and Employment of Pharmacy Technicians (Amend)
- Chapter 41: Sale of Nonprescription Drugs Through Vending Machine Outlets (Amend)
- Chapter 43: Prescribing, Dispensing and Administering HIV Prevention Drugs (New)
- Chapter 44: Pharmacist Authorization to Make Certain Contraception Accessible (New)
The next meeting will be a rulemaking subcommittee meeting on August 19, 2024.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Massachusetts
The Massachusetts Board of Registration in Pharmacy posted its August newsletter. Included in this newsletter is information about pharmacy license renewals.
Also in Massachusetts, the formal legislative session ended early in the morning on August 1. The legislature failed to pass a conference report for S2520, an Act relative to pharmaceutical access, costs and transparency. The bill would have included reporting to the Health Policy Commission, PBM licensure, audit regulations, prohibition of spread pricing and other fees and required drug rebates returned to consumer. As both chambers have unanimously passed their versions of the bill, there is a slight chance the legislature could advance the bill during informal sessions; however, only one member of a chamber is needed to prevent floor action. NACDS will continue to advocate for PBM policy principles in Massachusetts during the informal legislative session for the remainder of the year and prepare for the new session in 2025.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
The Board of Pharmacy posted the August 14 full Board and Disciplinary Subcommittee meeting agendas.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Department of Human Services announced that the new pharmacy adjudication system implementation date has been delayed until November 4, 2024.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Effective August 1, 2024, MO HealthNet (Medicaid) no longer covers DisposeRx packets.
Also in Missouri, if a pharmacy does not have a drug take-back receptacle, the Board of Pharmacy provides one for free through its Rx Cares for Missouri Medication Destruction and Disposal Program.
Finally in Missouri, the Board of Pharmacy adopted rules expanding pharmacy technician duties published in the August 1, 2024 Missouri Register (20 CSR 2220-2.715).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nevada
The Board of Pharmacy posted a hearing notice for the September 5 Public Hearing in Las Vegas on proposed new onerous counseling documentation requirements.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the New York State Medicaid Pharmacy Program, provided an update to its prior authorization program, effective August 1, 2024.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
Gov. Roy Cooper (D) declared a State of Emergency effective August 5, 2024, and it will remain in effect for 30 days. The Order activates the State Emergency Operations Plan and allows for the Department of Transportation and the Department of Public Safety to take the appropriate action to ensure the expeditious movement of utility vehicles to eliminate power outages, vehicles carrying essential supplies such as food, medicine and fuel or transporting livestock, poultry and crops. This order also triggers the Price Gouging Law.
Also in North Carolina, effective August 1, 2024, Medicaid beneficiaries may obtain the over the counter (OTC) oral contraceptive Opill without a prescription and at no cost. While Medicaid encourages establishing care with a medical home, coverage without a prescription allows Medicaid beneficiaries easy access to the product and reduces barriers such as having to make an appointment to get a prescription, needing transportation to the appointment or even a lack of health care providers in the community. Medicaid beneficiaries will be able to get Opill from pharmacies enrolled in Medicaid who will be able to submit the claim for reimbursement. A $5.00 fee will be included in the reimbursement amount paid to the pharmacy. A dispensing fee will not be paid. Beneficiaries are allowed to obtain up to a 3-month supply of Opill with each request, without a prescription, with a maximum of 13 packs per year. Opill is a progestin only contraceptive. Pharmacists should counsel beneficiaries that Opill is most effective when taken once a day at the same time each day.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
Effective August 12, 2024, OAC 4729:5-2-05 requires all outpatient pharmacies located in Ohio to submit notification to the Board of Pharmacy of the types of language translation services, hearing impairment services and vision impairment services they offer patients using the Board’s accessible services reporting webpage. Pharmacies are required to use this webpage to notify the Board of these accessible services. NOTE: The website (www.pharmacy.ohio.gov/ASreport) will go live on August 12, 2024; however, the requirement to submit notification of accessible services does not take effect until November 10, 2024. Chains can bulk report for all their locations but can only make changes moving forward by individual locations. The Board will issue a notification about the program to pharmacies on August 12. For now, only draft guidance is available.
Also in Ohio, the Department of Health is working with Innovation Horizons, a health consulting organization, to build up programs for diabetes prevention and management by increasing the number of pharmacies providing National Diabetes Prevention Program (DPP)/ Diabetes Self-Management Education and Support (DSMES) services to their patients. To better gauge the resources needed and capacities for pharmacies in the state, they created a survey for pharmacies to complete. Pharmacies are encouraged to complete the survey, if appropriate, as it may lead to further opportunities for patient care.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) posted the draft agenda for its next meeting on August 21. Please note the presentation by Myers and Stauffer titled “SB 192 Upper Payment Limit Deliverable” on the draft agenda. You must register in advance of the meeting to participate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The Department of Human Services published a bulletin to make providers aware of upcoming changes to its domain and URLs in the PROMISe payment system.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Gov. Henry McMaster (R) issued Executive Order 2024-16, declaring a State of Emergency in preparation for the potential effects of Tropical Storm Debby. Tropical Storm Debby is expected to produce rainfall totals of 10 to 20 inches, with maximum amounts of 30 inches, across portions of coastal South Carolina through Friday morning. This potentially historic rainfall may result in areas of catastrophic flooding. For power outages and shelter information, visit the S.C. Emergency Business Resources Dashboard. If your business sustains any damage during the storm, please be prepared to notify ESF-24 with as much detail as possible. ESF-24 will provide updates when assistance becomes available or business recovery centers open.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
TennCare announced the list of covered UPCs for its upcoming diaper program. Luvs, Pampers, Huggies and Cuties are the primary brands that will be covered. If your pharmacy plans to participate and wants to be featured on the TennCare website as a participating location, complete this survey.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
NACDS Mary Staples, Walgreens pharmacist Aimme Lusson, and Kroger pharmacist Jeff Loesch, met with State Sen. Bryan Hughes (R) and State Rep. Candy Noble (R), two champions for PBM reform legislation, at the Texas Pharmacy Association’s annual meeting in Allen, Texas.
Also in Texas, the Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP) delayed the semi-annual Medicaid preferred drug list update until August 8, 2024.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Vermont
Medicaid has updated its contact information due to the transition of Change Healthcare (CHC) to Optum.
| Contact | Old | New | |
| Help Desk | PBA_VTHelpdesk@changehealthcare.com Physicians: (p)1-844-679-5363 (f) 1-844-679-5366 Pharmacies: (p)1-844-679-5362 | VermontHD@optum.com Note: Phone and Fax numbers remain the same | |
| Provider paper billing address | 1 Green Tree Drive South Burlington, VT | 45 Commerce Dr, Suite 5 Augusta, ME 04330 | |
| PA Fax | Remains the same: 1-844-649-5366 | ||
Also in Vermont, the Department of Vermont Health Access (DVHA) continues a phased recovery following the outage that occurred in February 2024, due to the national cyber security issue affecting Optum/Change Healthcare. Beginning August 7, 2024, edits for Reject-75, Prior Authorization Required, will return to normal functioning in the pharmacy claims system.
- Claims for non-preferred items on the Preferred Drug List (PDL), including medications obtained during the outage, that do not have an active Prior Authorization on file, will now begin to reject. This also includes preferred medications subject to clinical review and medications requiring step therapy. Please refer to the PDL for medication specific coverage criteria.
- An emergency fill can be dispensed when a required prior authorization has not been secured, and the need to fill the prescription is determined to be an emergency. If the prescriber cannot be reached to obtain the required prior authorization, the pharmacist may dispense an emergency supply to last up to 72 hours.
Please continue to refer to the Preferred Drug List to review preferred and non-preferred medications. Providers requiring assistance with submitting a prior authorization may contact the Optum Pharmacy Helpdesk at VermontHD@Optum.com, the Prescriber Helpdesk at (1-844-679-5363) or the Pharmacy Helpdesk at (1-844-679-5362).
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Arizona
Gov. Katie Hobbs signed SB 1211 (Chapter 232), legislation allowing pharmacists to dispense naloxone hydrochloride or any other opioid antagonist approved by the US Food and Drug Administration without a signed prescription; removing the requirement that a pharmacist who dispenses naloxone hydrochloride or another opioid antagonist report outlined prescription information, including the name, strength, quantity, dosage and national drug code number of the drug; and removing the requirement that the Board of Pharmacy establish protocols for the dispensing of naloxone hydrochloride and other opioid antagonists.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
The Insurance Department (AIO) issued a Bulletin_10-2024 reminding insurers that Arkansas Health and Opportunity for Me (ARHOME) is the payor of last resort.
For more information, contact NACDS’ Mary Staples at 817-442-1155.