Virginia
Gov. Glenn Youngkin (R) vetoed companion bills (HB 570 / SB 274) that would have created a Prescription Drug Affordability Board (PDAB) in the state. This move comes as three other states actively conduct affordability reviews of prescription drugs nationwide. NACDS will be monitoring the final outcome of the bill when the Legislature returns later this spring for its veto session. NACDS joined other organizations in expressing opposition to the bill to Gov. Youngkin.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
NACDS applauds the enactment of ESSB 5213, a new law signed by Gov. Jay Inslee (D) on March 25 that will hold PBMs accountable. Although the law exempts the Employment Retirement and Security Act (ERISA) plans, it enhances the Insurance Commissioner's enforcement authority, establishes an appeals process, opens the network, includes anti-steering and mail order provisions, prohibits spread pricing and expands Maximum Allowable Cost appeals to all prescriptions, not just generic drugs. The bill sponsor, Sen. Patty Kurderer (D), who is running for the office of Insurance Commissioner in November, plans to enforce this new law and actively seek further PBM reforms, if elected.
Also in Washington, the Heath Care Authority asked NACDS to alert pharmacies that recently they have seen delays from its switch vendors and/or software vendors in applying changes for testing. Sarah Stewart said these changes to the BIN number and other information on the payer sheet for its POS (point of sale) replacement system are going live on April 27, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
The Centers for Medicare & Medicaid Services (CMS) approved an extension effective March 26, 2024, through December 31, 2028, for a 1115 “Behavioral Health Reform” demonstration project. This approval continues the state’s existing authority to receive federal financial participation (FFP) for providing clinically appropriate substance use disorder (SUD) treatment services for short-term residents in residential and inpatient treatment settings that qualify as an institution for mental diseases (IMD), as well as provides additional services to enhance the comprehensive and integrated behavioral health system for children, youth and adults with serious mental illness (SMI), severe emotional disturbance (SED) and/or SUDs (Substance Use Disorders).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
On March 29, Gov. Katie Hobbs (D) signed SB 1165 (Chapter 51), legislation outlining specified provisions an auditing entity must comply with when conducting a wholesale invoice audit and prohibits an auditing entity from retroactively reducing the amount of a claim unless specified criteria apply.
Also in Arizona, on April 2, Gov. Katie Hobbs (D) signed SB 1021, legislation removing the requirement that health professional groups proposing to increase the scope of practice of a state-regulated health profession must complete a statutory sunrise review.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
The Insurance Commissioner issued Directive 1-2024 suspending for 60 days the technical filing requirements, audits and recoupments related to claims for providers impacted by the Change Healthcare data breach.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Board of Pharmacy posted the following to its website:
- Licensing Committee Meeting – April 10 – Note: inclusion of technician, central fill and standard of care agenda items.
- Enforcement and Compounding Committee Meeting – April 11
- Legislation/Regulation Committee Meeting – April 11
Also in California, the Board of Pharmacy is conducting an occupational analysis (OA) of the pharmacy technician profession in California. The survey is a part of the OA, which identifies competencies that will provide the basis for developing future licensure examinations in California. The survey weblink will be available 24/7 and must be completed by April 15.
Finally in California, the Department of Health Care Services posted the following alerts, weekly notices, and monthly bulletin on the Medi-Cal Rx Web Portal.
- Removal of Code I Restrictions for Medical Supplies (April 1)
- Diabetic Test Strips and Lancets: Updates to the Code I Diagnosis and Quantity Limit Restrictions (April 1)
- Medi-Cal Rx Monthly Bulletin for April (April 1)
- Changes to the Medi-Cal Rx Contract Drugs List (April 1)
- Changes to the Medi-Cal Rx Pharmacy Reimbursable Physician Administered Drugs (April 1)
- Changes to the Medi-Cal Rx Contract Drugs List – Over-the-Counter Drugs and Cough/Cold Preparations (April 1)
- Changes to the Medi-Cal Rx Family Planning, Access, Care and Treatment Pharmacy Formulary (April 1)
- Updates to the Medi-Cal Rx Provider Manual (April 1)
- Mass Adjustment for COVID-19 Vaccine Incentive Fee for Impacted Claims Submitted February 1, 2022, through March 31, 2022 (March 29)
- Mass Adjustment for COVID-19 Antigen Tests for Impacted Claims Submitted on February 1, 2022 (March 29)
- Mass Adjustment for Disposable Insulin Delivery Devised for Impacted Claims Submitted January 1, 2022, through March 31, 2022 (March 29)
- Opill® Available for Over-the-Counter Under Medi-Cal Rx Prescription (March 29)
- 30-Day Countdown: Implementation of Reject Code 80 (March 29)
- Medi-Cal Rx Weekly Wrap-up March 22-28 (March 29)
- Pharmacy Claims Mass Adjustments: New Resources (March 28)
- Reminder: Medi-Cal Rx Secured Provider Portal Password Criteria Update Now in Effect (March 27)
- Updates to Paper Checks and Remittance Advices (March 27)
- Medi-Cal Rx Learning Management System Migration (March 25)
- Medi-Cal Rx Secured Provider Portal Password Criteria Update (March 25)
- Medi-Cal Rx Weekly Wrap-up for March 15-21 (March 22)
- Medi-Cal Rx Email Domains, Mailboxes and Meeting Links Transitioning to Prime
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
The state legislature is grappling with a $170 million budget shortfall as the state's constitution requires a balanced budget.
Also in Colorado, the Department of Health Care Policy and Financing (HCPF) reminded providers, including pharmacists, that they can deliver some laboratory testing services through a CLIA Certificate of Waiver. All claims for laboratory services must have the NPI (national provider identifier) of the provider who ordered the items to be indicated on the claim. The Billing Manual and more information on SUD (substance use disorder) benefits is available online.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Delaware
On April 1, the State Senate approved SB 194, an Act to Amend the Pharmacy Practice Act. This bill allows pharmacists, under protocol approved by the Department of Public Health, to provide HIV pre-exposure and post-exposure prophylaxis treatments. The proposal now moves to the House where NACDS will continue to support passage.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Florida
South Florida Community Care Network, LLC d/b/a Community Care Plan (Community Care Plan) currently provides behavioral health services. Beginning May 1, 2024, referrals, coordination and rendering of these services will also be provided by Ontrak Health. Members can receive behavioral health services from providers in Community Care Plan and Ontrak Health's network. Community Care Plan is an SMMC (Statewide Medicaid Managed Care) plan operating in region 10.
For dates of service beginning May 1, 2024, Ontrak Health's network providers should bill Ontrak Health for services rendered to Community Care Plan members. Community Care Plan's network providers should continue to bill Community Care Plan for behavioral health services. Providers participating in both Community Care Plan and Ontrak Health's network should use a unique Ontrak Health ID number when submitting their claims. Ontrak Health will be providing additional information for providers including the billing process.
Questions related to this transition may be directed as follows:
- Community Care Plan Member Services: 1-866-899-4828
- Community Care Plan Provider Services: 1-855-819-9506
- Ontrak Health Provider Services: 1-855-840-3627
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Idaho
NACDS sent a letter to Gov. Brad Little (R) encouraging him to sign HB 596, legislation to further regulate PBMs (Pharmacy Benefit Manager) (Pharmacy Benefit Manager) in the state and, on April 1, the Governor signed the bill and issued this transmittal letter. The bill includes provisions that would prohibit the use of "spread pricing." HB 596 also provides other vital reforms, including requiring 100% pass-through of manufacturer rebates to plan sponsors to keep patient premiums low, requiring that in-network pharmacies receive reasonable dispensing fees and implementing full disclosure and transparency requirements between the PBM (Pharmacy Benefit Manager) and the health plan, payor, and pharmacy.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
The Family and Social Services Administration’s Health Coverage Programs (IHCP) issued Bulletin BT202436 with pharmacy updates approved at the March meeting of the Drug Utilization Board.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kansas
As a result of our past efforts finally recognizing Kansas pharmacists as Medicaid providers that can be reimbursed for services that are not directly related to the dispensing of medications, the Department of Health and Environment (KDHE) provided the new billing codes. KDHE established a new provider type for non-dispensing services, including immunizations, for pharmacies and pharmacists to enroll.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
HB 579, legislation filed by Rep. Wayne McMahen (R) allowing pharmacists to screen patients, initiate therapy, administer and dispense PEP (Post Exposure Prophylaxis) and PrEP (Pre exposure Prophylaxis) medications, and receive payments at the same rate as other healthcare providers, was reported favorably from the House Health and Welfare Committee on April 3.
Also in Louisiana, HB 193, legislation filed by Rep. Chris Turner (R) that authorizes the transfer of a prescription or prescription information for controlled substances between pharmacies in conformance with federal regulations, unanimously passed the House on April 2 and was referred to the Senate.
Also in Louisiana, the next regular meeting of the PBM Monitoring Advisory Council on which NACDS has a designated Council seat is scheduled for April 11 and will be held in the Poydras Hearing Room (Ground Floor) at the Louisiana Department of Insurance. The meeting agenda includes instructions on how to participate in a Zoom meeting.
Finally in Louisiana, the Department of Health (LDH) issued Informational Bulletin 19-3, revising the options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCO) and the state's fee-for-service claims processor, Gainwell Technologies. Unless explicitly notated, providers should first seek resolution with the MCO or Gainwell directly, prior to engaging LDH or other third parties.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
North Carolina
The Board of Pharmacy President Andy Bowman has announced that he will be leaving Board service before the end of his term, which opens a vacant position in the Board's Southeastern District that will expire on April 30, 2026. To be eligible to run for this vacant Southeastern District seat, the candidate must be a pharmacist who holds an active North Carolina license to practice pharmacy and who resides (residential address, not work/practice address) in one of the counties comprising the Southeastern District. Interested pharmacists shall submit the following materials to the Board's Executive Director, Jay Campbell, by 5:00 pm on April 26. For more information for the soon-to-be vacant Southeastern Board Member position, please visit the Board's website.
- a letter of interest and any written materials the pharmacist wishes the Board to consider; and
- the signatures, legibly printed/typed names, and North Carolina pharmacist license numbers of ten (10) other pharmacists residing in the Southeastern District supporting the pharmacist's candidacy.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Maine
Gov. Janet Mills (D) ordered State Offices to be closed on April 4 due to anticipated weather conditions. The Pharmacy board meeting is cancelled. Unless otherwise decided, all matters on the Board’s agenda will be placed on the agenda for the next scheduled meeting on May 2.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Massachusetts
MassHealth issued the following two updates on March 26:
- Transmittal Letter ALL-246 – This letter transmits updates to 130 CMR 450.000: Administrative and Billing Regulations. Subsection 130 CMR 450.130 has been amended to reflect that MassHealth members will no longer be required to make copayments. Copayments have been temporarily eliminated since May 1, 2023; this update extends this policy indefinitely. These regulations are effective April 1, 2024.
- Managed Care Entity Bulletin 112 – This bulletin relates to certain drugs that may be used for the treatment of obesity that a provider purchased through the 340B Drug Pricing Program (340B stock). The bulletin applies to Accountable Care Partnership Plans (ACPPs), Managed Care Organizations (MCOs), One Care Plans and Senior Care Organizations (SCOs) (collectively referred to as "Managed Care Entities"). In MCE Bulletin 109, the Executive Office of Health and Human Services (EOHHS) directed Managed Care Entities not to pay for specified GLP-1 agonist drugs if those drugs were purchased through the 340B Drug Pricing Program, effective April 1, 2024. Through this Bulletin, EOHHS is delaying the effective date of this policy until July 1, 2024.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New York
On March 27, the State Department of Secondary Education published the following emergency orders in the New York Register (March 27, 2024, Vol XLVI, Issue 13).
- Pharmacist Dispensing Self-Administered Hormonal Contraceptives which was effective March 12, 2024, and
- Administration of Injectable Medications by Pharmacists for the Treatment of Mental Health and Substance Use Disorder, effective April 1, 2024.
Also in New York, the State Department of Health also issued a billing guidance on issuance of hormonal contraceptives. For NYRx billing, see below:
- To bill for the self-administered hormonal contraception, the pharmacy must submit a valid National Drug Code (NDC). Pharmacies must bill the Usual and Customary (U&C) price and will be reimbursed according to NYRx payment methodology and a $10.18 dispensing fee.
- To bill for the evaluation and management associated with the ordering of self- administered hormonal contraception, pharmacies will submit using the National Council for Prescription Drug Programs (NCPDP) D.0 claim format and enter one of the Healthcare Common Procedure Coding System (HCPCS) codes identified below.
- NYRx members may receive up to 12 months of prescription contraceptives at one time for family planning purposes as authorized by the Title 18 NYCRR Section 505.3(e).
- Pharmacies are expected to dispense up to the quantity limit of the prescription or Standing Order, one year supply, at the time of dispensing, pursuant to patient preference or primary insurance coverage limitations.
- Submitting any assessment code more than once a year requires cause.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Pennsylvania
Gov. Josh Shapiro (D) announced he will be issuing Guidance for Health Insurers to Improve Coverage for Over-the-Counter Contraception. Specifically, the Pennsylvania Insurance Department (PID) will issue guidance to insurers to provide coverage for over-the-counter contraception with or without a prescription. He further stated that PID will hold insurers accountable, requiring additional information from companies who chose not to cover OTC contraception.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
Please see the April 2024 Provider Update from Medicaid. All previous provider updates may also be on this webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The Department of Health and Human Services (SCDHHS) is announcing a further extension of telehealth flexibilities issued during the COVID-19 federal public health emergency (PHE).
SCDHHS previously issued guidance via Medicaid bulletins announcing the status of telehealth flexibilities upon the expiration of the federal PHE (Medicaid bulletin MB# 23-018). Flexibilities were grouped as those that were made permanent, continued for one year after the expiration of the federal PHE or expired upon the end of the federal PHE May 11, 2023.
Flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through December 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through December 31, 2024.
As a reminder, these extended flexibilities, including telehealth flexibilities, were included in the applicable Medicaid provider manuals prior to the end of the federal PHE. Provider manuals can be found on the SCDHHS website.
South Carolina Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members enrolled in an MCO.
Providers may direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday. Providers can also submit an online inquiry.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL (preferred drug list) may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. We encourage you to share this information with other TennCare providers. The individual changes to the PDL have been in this notice. The new PDL will be posted April 1, 2024. For details on clinical criteria, please visit OptumRx-TennCare.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The next meeting of the Texas Pharmaceutical Initiative Board will be in Austin at 10:00 am on April 9. The meeting agenda includes instructions for webcasting.
Also in Texas, Rep. Dr. Tom Oliverson (R) announced his candidacy for Speaker of the Texas House today for the 89th Session that convenes in January of 2025.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
NACDS applauds the enactment of ESSB 5213, a new law signed by Gov. Jay Inslee (D) on March 25 that will hold PBMs accountable. Although the law exempts the Employment Retirement and Security Act (ERISA) plans, it enhances the Insurance Commissioner’s enforcement authority, establishes an appeals process, opens the network, includes anti-steering and mail order provisions, prohibits spread pricing, and expands Maximum Allowable Cost appeals to all prescriptions, not just generic drugs. The bill sponsor, Sen. Patty Kurderer (D) who is running for the office of Insurance Commissioner in November, plans to enforce this new law and actively seek further PBM reforms if elected.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
The Board of Medical Examiners (BME) has certified rules for collaborative practice. A meeting between the Board of Pharmacy and the BME will be scheduled to work out the logistics for protocols on approval of agreements.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy proposes to adopt regulation changes dealing with closure of a pharmacy and examination requirements for licensure. Written comments are due April 10.
Also in Alaska, both pharmacy's patient freedom of pharmacy choice bills are moving forward in both houses but are facing stiff opposition. SB 121 was heard in the Senate Labor and Commerce Committee on March 20. HB 226 is pending in the House Labor and Commerce Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.