Arizona
On March 6, upon reconsideration, the Senate failed to pass SB 1085 by one vote. This bill would have authorized pharmacists to test and initiate treatment for conditions such as influenza, COVID, strep and other respiratory illnesses and to delegate the administrative and technical tasks of performing a test to a trained member of the pharmacy staff who is under the supervision of the pharmacist.
Also in Arizona, this week, the Department of Health Services (ADHS) launched a naloxone campaign aimed at combating the state's opioid overdose crisis. This multi-media campaign features stories from a diverse group of Arizonans whose lives were impacted by naloxone, connects those with substance use disorder to support resources, and demonstrates how to use naloxone to save lives. The FDA-approved injectable and nasal spray formulations are available over the counter, at pharmacies, community-based distribution programs, and through local health departments, making it possible for the public to also utilize naloxone to save lives. The ADHS encourages individuals to get it without a prescription at your local pharmacy.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Medi-Cal Rx Weekly Wrap-up for March 8-14 (March 15)
- Medi-Cal Rx Claim and Prior Authorization Request Submission Outage (March 14)
- Adalimumab biosimilar HADLIMA™ (adalimumab-bwwd) Added to Medi-Cal Rx Contract Drugs List on March 1, 2024 (March 8)
- Medi-Cal Rx Weekly Wrap-up for March 1-7 (March 8)
Also in California, the Department of Health Care Services posted the following:
- March 2024 Pharmacy Medi-Cal Update Bulletin
- March 2024 Durable Medical Equipment and Medical Supplies Medi-Cal Update Bulletin
Finally in California, Gov. Gavin Newsom (D) appointed Tyler Sadwith as State Medicaid Director at the Department of Health Care Services (DHCS). This is a long-awaited appointment to fill the second half of former Medicaid Director Jacey Cooper's position. As a reminder, Sarah Brooks was appointed in December as Chief Deputy Director of Health Care Programs at DHCS. Before that, Jacey Cooper held that position and the State Medicaid Director role. Her role was bifurcated and now Tyler Sadwith holds the Medicaid Director role and Sarah Brooks maintains the Chief Deputy Director of Health Care Programs position.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
On March 26, the Board of Pharmacy will be holding its regularly scheduled meeting at 9:30 am; virtual participation is available. The Legislative Committee will be meeting immediately prior to the Board meeting and discussing pharmacist’s “right to refuse” and flavoring prescriptions.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Florida
The Agency for Health Care Administration (AHCA) scheduled a hearing for Rule 59G-1.010, F.A.C., Definitions on April 3 from 2:00 pm to 2:30 pm.
LOCATION:
Agency for Health Care Administration
2727 Mahan Drive
Building 3
Tallahassee, FL 32308
A virtual option or call-in number will not be available for this meeting.
Official notice of the meeting published in Vol. 50/No. 50, of the Florida Administrative Register (FAR) on March 12, 2024. A copy of the notice may be found at: www.flrules.org
Please note that a preliminary draft of the reference material, if available, will be posted prior to the workshop on the AHCA Rules web page.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Idaho
On March 18, Gov. Grad Little (R) signed HB 527,legislation putting into statute the current practices of pharmacy that were either part of rule or standard procedures, but not codified. This will give stability to the changes that have helped to expand access to pharmacy services in the state.
Also in Idaho, HB 596, related to PBM (Pharmacy benefit managers) reform, was amended, and passed the Senate. It has been referred to the House Health & Welfare Committee for concurrence. 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 (Pharmacy benefit managers) to report to the Department of Insurance in a transparent way.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kansas
The Board of Pharmacy is seeking pharmacist feedback by March 29 on the pharmacist's use of the Collaborative Drug Therapy Management Committee's adopted 2023 Statewide Protocols for Influenza, Group A Streptococcal Pharyngitis and Urinary Tract Infection (UTI).
Also in Kansas, the Board of Pharmacy reminded pharmacies that prescriptions should only be reported to K-TRACS after they are sold and picked up by the patient, mailed or sent out for delivery. Prescriptions that are filled but not yet sold or are placed on hold for future pickup should not be reported to K-TRACS until they have been sold and picked up by the patient. Information about submitting void and revised records is available in the K-TRACS Dispenser Guide for use by software vendors.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
MedImpact recently issued communications to pharmacies regarding the State of Emergency Override and opportunities to reverse claims affected by the migration of Medicaid fee–for–service claims.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Two new final rules were published in the March 20 Louisiana Register, effective immediately. The PMP rule streamlines the CDS (controlled dangerous substance) license reinstatement process, updates the facility CDS license change of ownership procedures, and adds a new subsection to address changes to CDS license status. The Pharmacist Application rule removes the requirement to submit an application for initial pharmacist licensure to the Board at least 30 days prior to any examination.
Also in Louisiana, the 2024 regular session of the Louisiana legislature convened on March 11. The Louisiana Alliance of Retail Pharmacies and NACDS' top priority this session is to advance a PEP/PrEP bill, HB 579, filed by Rep. Wayne McMahen (R). The bill has been referred to the House Health and Welfare Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The Department of Health and Human Services (DHHS) announced it is expanding interim pharmacy payments to include pharmacies that are part of Maine-based health systems, in response to the continued disruption of MaineCare’s pharmacy claims due to the national cyber security issue with Change Healthcare. The amount of the interim payment for these Maine health system-based pharmacies will equal 75% of the average weekly MaineCare reimbursement to each qualifying pharmacy before the disruption. The payments already in place for independent and safety net pharmacies will continue to equal 100% of the average weekly MaineCare reimbursement amount from before the disruption, as these pharmacies are more dependent on MaineCare pharmacy revenue to continue ongoing operations.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Maryland
Pharmacy reached an important milestone in our effort to make PREP Act immunization authority permanent as our companion bills, SB 18 and HB 76, both passed their respective chambers of origin last week. We are cautiously optimistic that the bills will pass in the opposite chamber prior to sine die.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
New York
On March 19, the State Department of Health Commissioner signed a standing order regarding the new law authorizing pharmacist dispensing of hormonal contraception. The standing order signed by the State Health Commissioner pertains to three types of self-administered hormonal contraceptives that are approved by the federal Food and Drug Administration to prevent pregnancy, which include the following:
- Oral hormonal pill
- Hormonal vaginal ring
- Hormonal contraceptive patch
Pharmacists who choose to participate can dispense up to 12 months of a self-administered hormonal contraception of the individual's preference and covered under insurance.
Also in New York, the Office of Health Insurance Programs of the State Department of Health has approved the release of the February 2024 Medicaid Update. The update includes:
Pharmacy:
- Reminder: Pharmacies Submitting Medicaid 340B Drug Claims (Cover)
- Reminder: Pharmacy Coverage Includes Over the Counter Naloxone
Policy and Billing:
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
South Dakota
On March 5, Gov. Kristi Noem (R) signed HB 1147, legislation addressing discriminatory acts against entities participating in a 340B drug pricing program.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
TennCare recently released its latest Provider Notice listing changes to the TennCare Pharmacy Program and PDL (Preferred Drug List), effective March 1. Additionally, TennCare launched a newsletter containing up to date TennCare pharmacy information and details from the Pharmacy Provider Notices. Those interested may subscribe.
Also in Tennessee, false prescriptions are being called into pharmacies under Francisco J. Soto, MD, MS, FCCP, who sees patients at University Pulmonary & Critical Care. The phone number used to call in these fraudulent prescriptions may appear to come from a UTMC (University of Tennessee Medical Center) phone number. Pharmacies are advised to contact Renae Gibson at Dr. Soto's office at 865-524-7471 with any questions regarding his prescriptions.
Finally in 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). For details, please see a list 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 Prescription Monitoring Program's (PMP) Advisory Committee is meeting remotely on March 28. The meeting materials and agenda will be posted, when available.
Also in Texas, the Health and Human Services Commission (HHSC) provided an update to the Clinical Prior Authorization Assistance Chart, identifying which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.
- Change in Preferred Drug List Status for "Immunosuppressives, Oral" Drug Class
- VDP System Transition Information Available
- Updated Payer Sheets Available
Finally in Texas, the Health and Human Services Commission (HHSC) selected Gainwell Technologies as the pharmacy benefit administrator for the Vendor Drug Program. Gainwell will continue to use the National Council for Prescription Drug Programs (NCPDP) standard D.0 telecommunication standard format for pharmacy claim transactions beginning on March 30.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
On March 13, Gov. Spencer Cox (R) signed SB 207, legislation that prohibits the use of extrapolation in pharmacy audits among various other provisions to update the Pharmacy Practice Act.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Washington
The Pharmacy Quality Assurance Commission (PQAC) will hold a rules workshop during the May 2-3 business meeting on draft rule language regarding prescription transfers. The draft rule language discussed at the March 7 meeting was amended (WAC 246-945-345) to clarify noncontrolled prescription transfers, and language was added (WAC 246-945-346) relating to controlled substance prescription transfers. The PQAC is soliciting written comments on the draft rule language through April 5. Submit comments to PharmacyRules@doh.wa.gov; oral comments may be provided at the May rules workshop.
Also in Washington, the Health Care Authority (HCA) hosted a Prescription Drug Affordability Board (PDAB) meeting on March 20. More information about the PDAB is available on the website.
Finally in Washington, the 2024 Regular Session adjourned sine die on March 7. Our #1 priority bill in the state, a PBM reform bill filed by Sen. Patty Kurderer (D), ESSSB 5213, passed both houses and was delivered to Gov. Jay Inslee (D). Although the bill exempts 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 MAC appeals to all prescriptions, not just generic drugs.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alaska
PBM (Pharmacy Benefit Management) reform bills NACDS supports continued to advance this week. SB 121 was heard in the Senate Labor and Commerce Committee and HB 226 was heard in House Labor and Commerce on Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The following bills will be heard in the House Regulatory Affairs Committee on March 13:
- SB 1164, legislation prohibiting PBMs (Pharmacy Benefit Managers) from limiting or excluding coverage of a prescription drug for any covered individual who is on a specific prescription drug when certain conditions are met; prescribing formulary change notification requirements; and establishing a prescription coverage exemption determination process.
- SB 1165, legislation prohibiting an auditing entity from retroactively reducing the amount of a claim payment to a pharmacist or pharmacy after adjudication of the claim for a prescription drug, with certain exceptions and prescribes requirements for a wholesale invoice audit.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the following alerts, weekly notices, and monthly bulletin on the Medi-Cal Rx Web Portal:
- Planned Maintenance of Medi-Cal Rx Fax Lines (March 4)
- Medi-Cal Rx Weekly Wrap-up for February 23-29 (March 1)
- Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice (March 1)
- Medi-Cal Rx Monthly Bulletin for March (March 1)
- Changes to the Medi-Cal Rx Contract Drugs List (March 1)
- Updates to the Medi-Cal Rx Provider Manual (March 1)
Also in California, on March 4, "Provider Resources Amidst Change Healthcare Cybersecurity Issue" 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
The state's Consortium for Prescription Drug Abuse Prevention's
Annual Report is available here. This Consortium coordinates Colorado's response to the misuse of medications such as opioids, stimulants, and sedatives. Its mission is to reduce prescription drug misuse and abuse in Colorado by developing policies, programs, and partnerships with the many Colorado agencies, organizations, and community coalitions addressing one of the state's major public health crises.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Florida
The Agency for Health Care Administration has rescheduled the hearing for Rule 59G-4.250, F.A.C., Prescribed Drug Services, noticed in Vol. 50, No. 31, February 14, 2024, Florida Administrative Register, for March 20, 2024, from 2:00 to 2:30 p.m. at the Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Tallahassee, FL 32308.
A call-in number or virtual option will not be available for this hearing. Official notice of the rescheduled hearing published in Vol. 50, No. 40, of the Florida Administrative Register (FAR) on February 27, 2024. A copy of the notice may be found on the FAR website.
Please note that a preliminary draft of the reference material, if available, will be posted prior to the workshop on our Rules Web page.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Hawaii
On March 5, HB 2553, legislation expanding pharmacists' immunization authority for minors, passed the House and was transmitted to the Senate.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
Sent a notice to inform providers that, due to the continued prevalence of Respiratory Syncytial Virus (RSV), the Department of Healthcare and Family Services (HFS) is extending its coverage for Synagis (palivizumab) through March 31, 2024. This applies to customers covered under Medicaid fee-for-service (FFS) or a managed care plan. Providers should contact the appropriate managed care plan for approval guidance.
Due to the security breach and subsequent system outage at Change Healthcare, HFS' Pharmacy Benefits Management System (PBMS) for the FFS program, providers are unable to obtain prior approval. Providers billing on the 837 Professional claim format may submit their claims for Synagis without prior approval. Pharmacies are encouraged, in good faith, to continue to provide this medication as needed. Once the system is operational, HFS will make pharmacies whole and assist with claim submissions and provide any necessary overrides.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565, or the appropriate managed care plan.
Also in Illinois, HFS would like to thank our pharmacy partners who have been working tirelessly to ensure Medicaid customers receive their necessary medications. During this system outage, medications, including medications that normally require prior authorization, will not be subject to a post approval process. HFS will pay all clean claims submitted once the PBMS system is operational. Prescriptions filled in good faith will be paid in full as soon as the issue is resolved. HFS cannot provide an estimate on when the system issue will be resolved.
We want to reiterate that pharmacies should continue to check eligibility, which they can do by checking one of the following resources:
- MEDI – www.myhfs.illinois.gov
- AVRS – 800-846-1461
- Recipient Eligibility Verification (REV) System
- During business hours, calling 800-252-8942 or 877-782-5565 Option 7
Additionally, pharmacists should take particular care to consult with their patients regarding their current medications, and health and medication history to reduce the risk of adverse events.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Idaho
HB 527 passed the House and was assigned to the Senate Health & Welfare Committee where it was reported out of committee with “Do Pass Recommendation.” If enacted, this bill puts into statute the current practices of pharmacy that were either part of rule or standard procedures, but not codified. This will give stability to the changes that have helped to expand access to pharmacy services in the state.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
A HIVPEP/PrEP bill, HB 579, was pre-filed by State Rep. Wayne McMahan (R). The bill is modeled after the 2023 Arkansas law (Act 314).
Also in Louisiana, the Department of Health (LDH) issued an Informational Bulletin 24-3: updating the immunization fee schedule.
For more information, contact NACDS’ Mary Staples at 817-442-1155.