Kentucky
MedImpact issued an invitation and online access instructions to the 3rd Quarter session of the KY Medicaid Pharmacy Network Provider Webinar Forum on July 31 from 10:00-11:00 am EST. The meeting is meant as an open forum to ask questions or raise issues and all pharmacy providers are invited.
Also in Kentucky, MedImpact announced that they will be reprocessing claims that were inadvertently paid at NADAC or WAC when they should have been a MAC claim.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Walmart pharmacist Jeremy Moffett was chosen by his colleagues as the 2024 Louisiana Chain Pharmacist of the Year. He received recognition during the awards ceremony at the annual meeting of the Louisiana Pharmacy Association in Lafayette on July 12.
Also in Louisiana, the Department of Health’s Medicaid Director Kimberly Sullivan issued a pharmacy provider memorandum on the diagnosis code policy.
Also in Louisiana, the Board published Bulletin No. 24-01 which contains notice and guidance in regard to Act 246 of the 2024 Legislative Session.
Finally in Louisiana, the Department of Health’s (LDH) Medicaid team and Myers and Stauffer held a Zoom stakeholder meeting on July 15, sharing its plans for conducting a pharmacy cost of dispensing (COD) study. The survey will be emailed to a key point of contact for each chain pharmacy on August 7. The survey results will be used to evaluate the Medicaid pharmacy reimbursement methodology.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Michigan
The Department of Health and Human Services issued two bulletins announcing the upcoming termination of coverage for certain pharmacy services due to the upcoming expiration of the federal PREP Act.
- 2419-Lab – Termination of COVID-19 Home Test Kit Coverage and Special Reimbursement for COVID-19 Specimen Collection and Clinic Vaccine Administration. Comments may be forwarded to the e-mail noted on the policy’s transmittal sheet.
- 2424-Pharmacy – End of the Federal Public Health Emergency (PHE) and Final Unwinding of Pharmacy COVID-19 Response Policies. Comments may be forwarded to the e-mail noted on the policy’s transmittal sheet.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Missouri
Due to the increase in the Pharmacy Reimbursement Allowance (Pharmacy Tax), the adjustment to account for the Medicaid-reimbursed prescriptions was increased effective July 1, 2024. In-state pharmacy providers will continue to receive a professional dispensing fee of $12.22, plus an adjustment to account for the cost of the Pharmacy Reimbursement Allowance attributable to Medicaid-reimbursed prescriptions. The professional dispensing fee plus the current adjusted amount will total $12.42. Out-of-state pharmacy providers will continue to receive a professional dispensing fee of $8.85. Long-term care pharmacy providers supplying covered drugs to participants in long-term care facilities will continue to receive an additional $0.50 dispensing fee.
Also in Missouri, Gov. Mike Parson (R) allowed legislation NACDS supported, SB 751 relating to the distribution of 340B drugs, to become law without his signature, effective August 28, 2024.
Finally in Missouri, registration is open for the Board of Pharmacy’s “Lunch with the Chief Inspector” webinar on the 2024 legislative session and other Board of Pharmacy activities.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services posted the Excel file of the fee schedule for Injectables July 1, 2024.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The Board of Pharmacy’s board book was posted in advance of the two-day July meeting in Las Vegas.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Hampshire
On July 18, 2024, the Joint Legislative Committee on Administrative Rules is expected to make permanent Pharmacy Code of Conduct regulations that were previously proposed by the Board of Pharmacy. The regulations include a list of eleven ethical standards for pharmacists.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New Mexico
The Pharmacists Association (NMPhA) announced its new Executive Director, Alexandra (Lex) Garcia. Lex replaces Dale Tinker, who has been at the helm of the association for 35 years.
Also in New Mexico, despite pushback from Democratic leadership, Gov. Michelle Lujan Grisham (D) called the legislature into a 30-day (or less) special session beginning on July 18.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On July 17, 2024, NYRx, the State Medicaid Prescription Drug Program, hosted its monthly pharmacy call. The agenda included:
- Pharmacy Reimbursement & Dispensing Fee Calculations
- Pharmacy Enrollment: Pharmacies Pending Medicare Part B Revalidation
- Vaccine Billing
The next call will be August 21, 2024.
Also in New York, the Office of Health Insurance Programs of the State Department of Health has approved the release of the June 2024 Medicaid Update. It included the following:
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
The Controlled Substance Reporting Act requires that gabapentin dispensing be reported by pharmacies. Gabapentin is not a controlled substance (under federal or North Carolina law), but its dispensing must nonetheless be reported to the Controlled Substances
Reporting System (CSRS). The Drug Control Unit of the Department of Health and Human Services administers the CSRS and has provided questions and answers concerning gabapentin reporting. That guidance is found in the “What information must be reported to the CSRS?” frequently asked questions.
Also in North Carolina, the next Board of Pharmacy election is scheduled to begin November 1, 2024. Two positions on the Board will be filled, the Northeastern District seat presently held by Wallace Nelson and the Central District seat presently held by Ashley Duggins. Board staff will hold Q & A sessions for anyone considering running for one of these positions or for anyone wanting more information about Board service. The first session will be on July 31, 2024, at 7:00 pm, Hampton Inn in Rocky Mount. The second info session will be on August 28, 2024, at 7:00 pm, Hampton Inn in Concord. Complete details will be posted and sent out by the Board next week.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Board of Pharmacy has published a final rule amending language prohibiting retaliation in response to requests for additional staff and reports of staffing concerns. The Rule will be effective July 25, 2024.
Also in Ohio, Medicaid and Myers and Stauffer hosted a webinar to brief pharmacy associations about the mandatory upcoming biennial Cost of Dispensing Study. Please review the slide deck and the DRAFT Cost of Dispensing study for more details. Survey forms will be sent to all pharmacies July 25 via both snail mail and email and are due back August 29. Please see pages 9-11 of the slide deck for specific information options for chain pharmacies to submit batch data for all stores.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oregon
The Prescription Drug Affordability Board (PDAB) posted the agenda and meeting materials for its next meeting on July 24. Please register in advance of the meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
After several weeks of intense negotiations and multiple meetings among the General Assembly and stakeholders, HB 1993 (Rep. Jessica Benham-D) passed and was signed by Gov. Josh Shapiro (D) as Act 77 of 2024. The bill includes significant commercial PBM reform provisions and an expansion of pharmacist immunization authority to include ACIP vaccines for children aged eight years and older and pharmacy technician immunization authority for COVID and Flu for ages 13 years and older. Many thanks to the Pennsylvania Association of Chain Drugs Stores, the Pennsylvania Pharmacists Association and Value Drug Co. and all who put many hours of work into getting it across the finish line.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
Gov. Henry McMaster (R) signed HB 3988, legislation that authorizes pharmacists to administer non-flu vaccines to persons 16 years of age and older, to order and administer flu and COVID tests and to delegate both vaccine administration and the administration of tests to pharmacy technicians working under their supervision. The act took effect upon signature of the Governor.
Also in South Carolina, on July 1, 2024, the Department of Health and Environmental Control (DHEC) became two separate agencies, the Department of Environmental Services (SCDES) and the Department of Public Health (DPH). Additionally, DHEC’s retail food program and milk and dairy lab moved to the Department of Agriculture (SCDA). You can visit the linked agencies for your needs or visit the DHEC homepage to choose the correct agency website.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
CVS Caremark will contact low-volume pharmacies and pharmacy services administrative organizations (PSAOs) this month with information regarding its re-billing and re-processing updates to comply with 2022’s Public Chapter 1070 for claims from January-October 2023. Due to the switch from AWP to NADAC pricing, some pharmacies may need to pay recoupment fees to CVS Caremark. The Tennessee Pharmacy Association has been in contact with CVS Caremark representatives and legislative leadership and is working to communicate with PSAOs about this change and next steps pharmacies can take to prevent financial losses. Pharmacies should submit rate review requests to CVS Caremark before submitting external appeals to the Department of Commerce and Insurance to rectify this situation.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Virginia
The Board of Pharmacy issued the following communication to licensees:
“In response to House Bill 2147, passed during the 2023 General Assembly Session, the Board of Pharmacy is reminding pharmacy personnel that federal laws require minimum standards in certain situations regarding patient translation services for prescription drugs. Specifically, pharmacy personnel are encouraged to review and consult with their management regarding the pharmacy’s compliance with the following federal laws: Title VI of the Civil Rights Act 1964 (42 U.S.C. 2000d) regarding discrimination based on race, color, or national origin by any program or activity receiving federal financial assistance; Section 504 of the Rehabilitation Act (29 U.S.C. § 794) regarding discrimination based on a disability from any program or activity receiving federal financial assistance; and Title III of the American with Disabilities Act (42 U.S.C. §§ 12181 to 12189; 28 C.F.R. Pt. 36) regarding discrimination at a place of public accommodation which includes a pharmacy. Please note the Board is unable to provide legal advice on this matter. However, additional information may be found in the Board of Pharmacy Report Regarding the Provision of Translated Directions for Use of Prescriptions submitted to the Virginia General Assembly on December 7, 2023.Please also be aware that the Board will adopt regulations and guidance by December 31, 2024, for accessible prescription labels to assist the blind, visually impaired, or otherwise print disabled as required by House Bill 516, passed during the 2024 General Assembly Session.”
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Washington
The Department of Health posted its July monthly bulletin “epiTRENDS”.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arkansas
The Insurance Commissioner (“Commissioner”) issued Advisory Bulletin 8-2024 to all Insurance Department (“AID”) licensed pharmacy benefits managers (“PBMs”) related to PBM reimbursements to pharmacies at minimum levels to NADAC pricing amounts under Ark. Code Ann. § 23-92-506(b)(5)(A). The Commissioner had received several complaints from pharmacies against PBMs in which a PBM has reversed a payment to reduce or to remove a dispensing fee in the pharmacy’s compensation to equalize the payment to NADAC minimum pricing. Questions concerning this Bulletin should be directed to Legal Division at 501-371-2820 or by email at Insurance.Legal@arkansas.gov.
Also in Arkansas, Tim Griffith, the Attorney General is suing PBMs for their role as a cause of the opioid epidemic in Arkansas.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Servies posted the following alerts, weekly notice and monthly bulletin on the Medi-Cal Rx Web Portal.
- State of Emergency Override Activation: Submission Clarification Code 13
- Medi-Cal Rx Weekly Wrap-up for June 28-July 4
- Medi-Cal Rx Monthly Bulletin for July
- Changes to the Medi-Cal Rx Contract Drugs List
- Changes to the Medi-Cal Rx Contract Drugs List – Authorized Drug Manufacturer Labeler Codes
- Updates to the Medi-Cal Rx Provider Manual
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Hawaii
Gov. Josh Green (D) signed HB 2553 (Act 104), permitting pharmacists to order and administer ACIP-approved vaccines to persons three years of age or older and authorizing pharmacy interns and pharmacy technicians under the direct supervision of a licensed pharmacist to administer vaccines to persons three years of age or older, if properly trained.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Louisiana
ACT 246 (SB 276) creates the crime of coerced criminal abortion by means of fraud when a person knowingly and intentionally engages in the use of an abortion-inducing drug on a pregnant woman, without her knowledge or consent, with the intent to cause an abortion, effective October 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The Board of Pharmacy has given Notice of Proposed Rule-Making. The Board will be hearing public comments on August 1 at 8:30 am online or in-person. These proposed set of rules are in response to several laws enacted by the 131st Legislature:
- setting standards by which a pharmacy technician may qualify to be certified to administer vaccines;
- repeals the 12-item limit for drug outlet vending machines;
- establish standards for authorizing pharmacists to prescribe, dispense and administer HIV prevention drugs, set adequate training requirements and protocols for when there is no prescription drug order, standing order or collaborative practice agreement; and
- implement requirements to increase access to birth control by making certain contraception accessible from a pharmacist.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New Mexico
The Department of Health Care Medical Assistance Division notified Medicaid Pharmacy Providers that some of the Group and PCNs were incorrect. Here’s the updated list:
Presbyterian
- PBM Name: Capital RX
- BIN: 610744
- PCN: CRXMC
- Group: PHPCAID
United Healthcare
- PBM Name: Optum Rx
- BIN: 610494
- PCN: 4941
- Group: ACUNM
Molina
- PBM Name: CVS Caremark
- BIN: 004336
- PCN: MCAIDADV
- Group: RX51EA
Blue Cross Blue Shield
- PBM Name: Prime Therapeutics
- BIN: 011552
- PCN: SALUD
- Group: N72100 – N/A
Fee-For-Service
- PBM Name: Conduent
- BIN: 610084
- PCN: DRNMPROD
- Group: NEWMEXMED
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the State Medicaid Prescription Drug Program, posted a Pharmacy Prior Authorizations Programs Update. This update is effective August 1, 2024.
Also in New York, the Office of Health Insurance Programs of the State Department of Health has approved the release of the May 2024 Medicaid Update. This update includes a pharmacy reminder that Medicaid providers are required to bill applicable third parties that may be liable for a claim before billing Medicaid. Medicaid is always the payor of last resort and federal regulations require that all other available resources be used before Medicaid considers payment.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The Ohio Board of Pharmacy issued the following communications:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.