Florida
The Department of Revenue has announced that, effective June 1, 2024, the state sales tax rate imposed under section 212.031, Florida Statutes (F.S.), on the total rent charged for renting, leasing, letting, or granting a license to use real property (also known as “commercial rentals”) is reduced from 4.5% to 2.0%. Information about the proper reporting of tax due on commercial rentals is available on the Department’s website at floridarevenue.com/forms. For more information, please review the Department’s Taxpayer Information Publication.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Illinois
The April 4, 2024, provider notice includes an update to pharmacies on billing for the COVID-19 vaccine administration fee. This update applies only to the Medicaid fee-for-service program for dates of service beginning September 11, 2023, through December 31, 2023.
A September 28, 2023, provider notice stated the Department of Healthcare and Family Services (HFS) was still finalizing programming for the administration fee for the COVID-19 vaccine, and providers could not include administration fee charges on their claims at that time. Pharmacies could still provide COVID-19 vaccinations and submit claims to HFS for reimbursement for the cost of the vaccine and a professional dispensing fee, without an administration fee.
HFS has completed part of the programming for pharmacies to receive the applicable administration fee for COVID-19 vaccines. Pharmacies can now void and rebill claims that were initially submitted without the administration fee for dates of service beginning September 11, 2023, through December 31, 2023. Pharmacies must use "MA" in the Professional Service Code Field, in addition to identifying the administration fee.
Claims with dates of service beginning January 1, 2024, must continue to be billed without an administration fee until further notice.
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.
Indiana
The Family and Social Services Administration's (FSSA) Indiana Health Coverage Programs (IHCP) announced a Roadshow at six locations throughout the state to be held April 30 through June 6, 2024. Providers are encouraged to come prepared with any policy-related questions. Please do not bring actual claims or claim-related questions to the event.
Also in Indiana, IHCP issued a bulletin BT202434 detailing the program beginning on May 1, 2024, that will align the fee-for-service continuity of care with managed care.
Finally, the Office of Medicaid Policy and Planning (OMPP) is hosting an informational webinar on the PathWays for Aging program April 18. OMPP staff will provide an overview of the PathWays program which is set to launch on July 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
Gov. Andy Beshear (D) signed HB 274, sponsored by pharmacist Rep. Danny Bentley (R). The bill authorizes pharmacists to order and administer vaccines to patients aged 5 years and older under a prescriber-approved protocol. The law takes effect 90 days after the General Assembly adjourns sine die. This date will officially be set by the attorney general after April 15.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health (LDH) provided new Policy memos on a variety of subjects:
- Louisiana Medicaid Pharmacy Point of Sale Quantity Limit – Effective April 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Age Requirements – Effective April 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Edits for Therapeutic Duplication and Prior Use – Effective April 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirement – Effective April 1, 2024
- Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates – Effective April 1, 2024
- Louisiana Medicaid Pharmacy Compound Drug Coverage for Managed Care Organizations (MCOs) – Effective April 1, 2024
Also in Louisiana, the PBM (Pharmacy Benefit Managers) Monitoring Advisory Council met on April 11 to discuss these agenda items. The draft minutes from the February 7 meeting are available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
Office of MaineCare Services provided this notice regarding claims filed by Pharmacy Providers during the outage period (February 21 through March 26). In collaboration with Optum Change Healthcare, Maine has updated the technical instructions to reflect recent feedback received from pharmacy providers about claims denials.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Minnesota
On April 12, the House Health and Finance Policy Committee will hear HF 3902, legislation that would increase the Medicaid Fee-for-Service Professional Dispensing Fee from $10.77 to $11.55 to match the most recent state cost of dispensing survey. Companion legislation in the Senate has already been heard and laid over for possible inclusion in the House Health Omnibus bill.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Mississippi
Save the date for the Mississippi Pharmacists Association’s Back to the Basics Consultant Seminar on April 18, 2024. Class offerings include “Consulting 101/Pharmacology,” “Appendix PP,” “Mental Health,” “Antibiotic Stewardship” and more. Attendees may receive eight hours of continuing pharmacy education (CPE).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Nevada
The agenda and meeting materials for the Board of Pharmacy’s April 17 – 18 meeting in Reno are available.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
The State Medicaid Pharmacy Benefit Program, NYRx, issued guidance for billing of long acting injectables for mental health and substance abuse treatment.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Oregon
Gov. Tina Kotek (D) signed HB 4149, PBM legislation that requires pharmacy benefit managers to be licensed by the Department of Consumer and Business Services beginning January 1, 2025; modifies the definition of "pharmacy benefit manager" and imposes new requirements on PBMs (Pharmacy Benefit Managers); restricts audits of pharmacy claims for reimbursement; requires PBMs to report specified information to the department on an annual basis; and imposes new requirements with respect to the insurance coverage of 340B drugs.
Also in Oregon, Gov. Tina Kotek (D) signed HB 4002, legislation permitting pharmacist dispensing of opioid use disorder medication refills and requires health insurers and community care organizations (CCOs) to reimburse the cost of refills of substance use disorder medications.
Finally in Oregon, the Prescription Drug Affordability Board posted the draft agenda and meeting materials for its next meeting on April 17. Please register in advance of the meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
HB 1993, a companion bill to SB 1000, a comprehensive commercial and Medicaid PBM reform bill has been introduced by Rep. Jessica Benhem (D). Both bills have strong bi-partisan co-sponsorship and support. NACDS continues to work collaboratively with the Pennsylvania Association of Chain Drug Stores and the Pennsylvania Pharmacy Coalition and legislators to advance these bills.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Tennessee
The Department of Commerce and Insurance (TDCI) shared a rule filing regarding PBMs. The TDCI regulations on audits of PBMs were approved and will take effect on June 26, 2024.
Also in Tennessee, congratulations to Dean Bill Gentry of South College School of Pharmacy, who announced his upcoming retirement effective July 2, 2024.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Texas Pharmaceutical Initiative (TPI) three-member Board held a hybrid meeting on April 9. Five of the largest state agencies on the Advisory Council (TIPAC) provided testimony, addressing issues such as prescription drug pricing, the potential for savings with a single PBM, specialty pharmacies drug pricing, the most expensive prescription drugs prescribed, drug shortages and rebates. HB 4990 passed during the 2023 Regular session requires TPI to present a plan for the legislature by October 1, 2024. The Board also has the authority to explore a distribution network and partnerships to launch a manufacturing facility for generic or biosimilar drugs. The Health and Human Services Commission (HHSC) recommended that the prescription drug importation program law aimed at providing lower cost prescriptions by importing them through Canada (HB 25-2023), also be addressed by TPI.
Also in Texas, the Gainwell point-of-sale claims system, the VDP (Vendor Drug Program) Provider Portal and the VDP eCOI (Electronic Certification of Information) Portal are now active.
Finally in Texas, the Board of Pharmacy posted proposed rules for prescription drug deliveries and non-sterile compounding in the March 22 Texas Register (see pages 1852-1863). Written comments on the proposed rules may be submitted to Eamon D. Briggs, Deputy General Counsel, Texas State Board of Pharmacy, 1801 Congress Avenue, Suite 13.100, Austin, Texas 78701-1319, FAX (512) 305-8061. Comments must be received by 5:00 pm on April 30, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
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.