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.
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.