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.
Maryland
The Maryland House and Government Operations Committee Subcommittee on Insurance and Pharmaceuticals met this week and advanced an amended version of HB 76, a bill that would expand pharmacists’ ability to immunize children. The negotiated amendment to the bill would allow pharmacies to provide COVID, flu and any vaccine available because of a public health emergency to children aged 3 and older, as well as all ACIP-recommended vaccines and travel vaccines to children 7 years of age and older. The bill was reported out of subcommittee with 3 negative votes. It now goes to the full House.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The Drug Utilization Review (DUR) Board posted the February 13 draft minutes. The next meeting will be held on May 7.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New York
On March 5th, the NYRx Clinical Call Center reported that they are experiencing higher than normal call and fax volume. Prescribers should not send duplicate prior authorization (PA) requests to NYRx. Prescribers may experience a higher volume of requests for PA, but only one submission is necessary. Pharmacies should only request one PA for each member for each drug. Duplicate requests slow down the processing time at the NYRx Clinical Call Center. For more information, refer to NYRx Notice to Providers: Duplicate Prior Authorization Requests. To review how to submit a PA to NYRx, refer to the NYRx Prior Authorization Submission Guide.
Enhancements have been made to the NYRx clinical criteria system editing. The clinical criteria have not changed and should be reviewed on the NYRx Preferred Drug List prior to obtaining a PA. Preferred products should be prescribed when clinically appropriate. In most cases, preferred products will not require a PA when prescribed according to FDA (FOOD AND DRUG ADMINISTRATION) labeling. To review NYRx preferred products only, refer to the NYRx Preferred Drug Quick List.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Missouri
The House Health & Mental Health Committee held a hearing Monday on PBM reform legislation, HB 1627 by Rep. Dale Wright. More than 40 pharmacists showed up at the Capitol to voice their support. The theme of the day was “Enough is enough” with PBM abuses. Go to the Missouri Pharmacy Association’s (MPA) website for more information.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
On March 4, the Board of Pharmacy issued this temporary rule notice:
- OAR 855-115-0345 Pharmacist- Services: Prescribing – Protocol Compendium – Vaccines – Coronavirus 19 (Effective March 4, 2024)
- Coronavirus 19 protocol
This revised protocol permits pharmacists to provide an additional updated 2023-2024 COVID-19 vaccine dose to adults ages 65 years and older in alignment with the recent recommendation of the CDC (Centers for Disease Control) Advisory Committee on Immunization Practices' (ACIP).
Also on Oregon, the Board of Pharmacy issued the following temporary rule notice:
- OAR 855-115-0345 Pharmacist- Services: Prescribing – Protocol Compendium Vaccines (Effective March 1, 2024)
- Standard Protocol for All Vaccines: Cover Page & Assessment and Treatment Care Pathway
- Standard Protocol for All Vaccines: Managing Adverse Reactions
- Cholera
- Coronavirus 19
- Haemophilus Influenzae type b
- Hepatitis A containing vaccines
- Hepatitis B containing vaccines
- Human Papillomavirus
- Influenza Inactivated Influenza Vaccines and Recombinant Influenza Vaccines 2023-2024
- Influenza Live Attenuated Influenza Vaccine 2023-2024
- Japanese Encephalitis
- Measles, Mumps & Rubella containing vaccines
- Meningococcal containing vaccines
- Pneumococcal
- Polio
- Rabies
- Respiratory Syncytial Virus
- Tetanus, Diphtheria containing vaccines
- Typhoid
- Varicella containing vaccines
- Yellow Fever
- Zoster
Also in Oregon, the Board of Pharmacy permanently repealed the following rules at the Special February 23, 2024, Board Meeting: OAR 855-019-0270, OAR 855-019-0280, OAR 855-019-0290 and OAR 855-025-0024 related to Pharmacist/COPT/PT Administration of Vaccines (Effective February 29, 2024)
Also in Oregon, the Board of Pharmacy permanently adopted the following rule at the February 2024 Board Meeting: OAR 855-115-0150 Pharmacist- Prohibited Practices (Effective March 1, 2024). Please note this rulemaking removes "Diagnosis" from the list of prohibited practices.
Finally in Oregon, the Prescription Drug Affordability Board posted the draft agenda for its next meeting on March 20. Please register in advance of the meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
The Board of Pharmacy’s proposed pharmacy technician registration regs were published on March 2 and are now before the Independent Regulatory Review Commission and the designated standing committees of the PA House and Senate for consideration. Comments are due to IRRC by April 1; after reviewing IRRC will provide any comments back to the BOP (Board of Pharmacy) by May 1. Members may submit comments to Jill McCormack by March 20.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
Please see the March 2024 Provider Update RI Medicaid. All previous provider updates may also be found here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
The Tennessee House Government Operations Committee met and voted on proposed Board of Pharmacy rules packets as the last step in the approval process. Several presented rules were approved, including those for the provision of ivermectin and accommodations for visually impaired patients, but the Committee disapproved the proposed rule 1140-07 Sterile Compounding. Rules pertaining to complying with USP recommendations will not be enforceable by TN inspectors on March 14 as originally anticipated; however, federal agencies still require compliance. TPA is working closely with the Department of Health on this issue and will share more details as they become available.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
Texas was one of 15 states who held their primary election contest on Super Tuesday. The ballot included President, U.S. Senator, all 38 U.S. House seats, Texas Supreme Court and Court of Criminal Appeals Justices, district attorney's and sheriffs, all 150 Members of the Texas House of Representatives and 15 State Senate seats. The House races were dominated the headlines with border, school choice/vouchers, and the Articles of Impeachment that were brought by the Republican-controlled House against the sitting Texas Attorney General Ken Paxton (R). Nine incumbents lost their seats, and nine incumbents are facing a primary runoff on May 28th.nIn fact, for the first time in more than 50 years, the Speaker of the House, Dade Phelan (R) has been forced into a runoff election.
Also in Texas, the Health, and Human Services Commission (HHSC) selected Gainwell Technologies as the pharmacy benefit administrator for the Texas Vendor Drug (VDP) Program. For pharmacies:
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Utah
Effective February 25, 2024, the Department of Health and Human Services adopted a rule implementing immunization requirements of Title 53G, Chapter 9. Part 3 Immunization Requirements. It establishes minimum immunization requirements for attendance at a public, private, elementary, or secondary school through grade 12, nursery school or kindergarten, licensed day care center, childcare facility, family home care or Head Start program in this state. Of note, pharmacists are among the licensed health care providers who may verify the administration of vaccines on any immunization record. (Utah State Bulletin 2024-03-01, p.92)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Washington
Prior to the March 7th adjournment date, pharmacies priority legislation, the PBM reform bill E2SSB 5213, passed both houses and was sent to Gov. Jay Inslee (D) to be signed into law.
For more information, contact NACDS’ Mary Staples at 817-442-1155.