New York
On March 27, the State Department of Secondary Education published the following emergency orders in the New York Register (March 27, 2024, Vol XLVI, Issue 13).
- Pharmacist Dispensing Self-Administered Hormonal Contraceptives which was effective March 12, 2024, and
- Administration of Injectable Medications by Pharmacists for the Treatment of Mental Health and Substance Use Disorder, effective April 1, 2024.
Also in New York, the State Department of Health also issued a billing guidance on issuance of hormonal contraceptives. For NYRx billing, see below:
- To bill for the self-administered hormonal contraception, the pharmacy must submit a valid National Drug Code (NDC). Pharmacies must bill the Usual and Customary (U&C) price and will be reimbursed according to NYRx payment methodology and a $10.18 dispensing fee.
- To bill for the evaluation and management associated with the ordering of self- administered hormonal contraception, pharmacies will submit using the National Council for Prescription Drug Programs (NCPDP) D.0 claim format and enter one of the Healthcare Common Procedure Coding System (HCPCS) codes identified below.
- NYRx members may receive up to 12 months of prescription contraceptives at one time for family planning purposes as authorized by the Title 18 NYCRR Section 505.3(e).
- Pharmacies are expected to dispense up to the quantity limit of the prescription or Standing Order, one year supply, at the time of dispensing, pursuant to patient preference or primary insurance coverage limitations.
- Submitting any assessment code more than once a year requires cause.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Pennsylvania
Gov. Josh Shapiro (D) announced he will be issuing Guidance for Health Insurers to Improve Coverage for Over-the-Counter Contraception. Specifically, the Pennsylvania Insurance Department (PID) will issue guidance to insurers to provide coverage for over-the-counter contraception with or without a prescription. He further stated that PID will hold insurers accountable, requiring additional information from companies who chose not to cover OTC contraception.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
Please see the April 2024 Provider Update from Medicaid. All previous provider updates may also be on this webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The Department of Health and Human Services (SCDHHS) is announcing a further extension of telehealth flexibilities issued during the COVID-19 federal public health emergency (PHE).
SCDHHS previously issued guidance via Medicaid bulletins announcing the status of telehealth flexibilities upon the expiration of the federal PHE (Medicaid bulletin MB# 23-018). Flexibilities were grouped as those that were made permanent, continued for one year after the expiration of the federal PHE or expired upon the end of the federal PHE May 11, 2023.
Flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through December 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through December 31, 2024.
As a reminder, these extended flexibilities, including telehealth flexibilities, were included in the applicable Medicaid provider manuals prior to the end of the federal PHE. Provider manuals can be found on the SCDHHS website.
South Carolina Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members enrolled in an MCO.
Providers may direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday. Providers can also submit an online inquiry.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL (preferred drug list) may occur as new classes are reviewed, and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. We encourage you to share this information with other TennCare providers. The individual changes to the PDL have been in this notice. The new PDL will be posted April 1, 2024. For details on clinical criteria, please visit OptumRx-TennCare.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The next meeting of the Texas Pharmaceutical Initiative Board will be in Austin at 10:00 am on April 9. The meeting agenda includes instructions for webcasting.
Also in Texas, Rep. Dr. Tom Oliverson (R) announced his candidacy for Speaker of the Texas House today for the 89th Session that convenes in January of 2025.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
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.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
The Board of Medical Examiners (BME) has certified rules for collaborative practice. A meeting between the Board of Pharmacy and the BME will be scheduled to work out the logistics for protocols on approval of agreements.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy proposes to adopt regulation changes dealing with closure of a pharmacy and examination requirements for licensure. Written comments are due April 10.
Also in Alaska, both pharmacy's patient freedom of pharmacy choice bills are moving forward in both houses but are facing stiff opposition. SB 121 was heard in the Senate Labor and Commerce Committee on March 20. HB 226 is pending in the House Labor and Commerce Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
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.