Vermont
Effective February 21, Change Healthcare started to experience network issues expected to continue throughout the weekend. To ensure Medicaid members receive necessary prescriptions and pharmacies have necessary guidance the agency offered the following:
- Claim Processing/Prescription and Emergency Fills: Claims are not processing currently. Existing federal law requires that a 72-hour emergency supply of a prescription drug be dispensed to Medicaid patients when the medication is needed without delay. Claims will be processed once the Change Healthcare system issues have been resolved. It is expected that providers will adhere to the provider agreements, which prohibit billing members when Medicaid will pay for services. Please refer to the provider manual for the limitations on billing members Vermont Medicaid Provider Manual (vtmedicaid.com).
- Eligibility: Eligibility must be verified through the automated Voice Response System (VRS), 800.925.1706, option 1 and then option 1 again or by utilizing online Transaction Services (https://vtmedicaid.com/#/home). For those members indicating new enrollment as of February 23, please call Maximus at 855-899-9600 during business hours and for afterhours please call the automated Voice Response System (VRS).
- Pharmacy Procedures: Many pharmacies have established internal procedures to handle such situations and we encourage dispensing medications to affected members to ensure continuity of care.
- Prior Authorizations: The outage is impacting the ability to issue prior authorizations. Therefore, prior authorization will be retroactively reviewed and applied for prescriptions filled during the system outage. Pharmacies must review the PDL to ensure the criteria is met prior to issuing new medications. Preferred Drug List (PDL) & Clinical Criteria | Department of Vermont Health Access
- Refills should be issued as requested based on the member's history and clinical judgement. These claims will also be subject to a retroactive review.
- Controlled substance prescriptions: Please review the Vermont Prescription Monitoring System (VPMS) system as required.
- Helpdesk Access: Due to the outage, pharmacies are temporarily unable to contact the pharmacy helpdesk via phone or fax. Change Healthcare has indicated that the cause of the outage has been identified and they are working actively to restore normal operations. For questions, contact the Department of Vermont Health Access Pharmacy team at 802-879-5000 or ahs.dvhaph@vermont.gov.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Washington
The PBM reform bill that passed the Senate earlier this month was amended in the House and continues to advance E2SSB 5213 through the legislative process despite the false claims that this bill would cost the state of Washington almost $239 million in excess drug spending in year one, and as high over $2.7 billion over the next 10 years. The bill is on the House calendar and must be voted out by 5:00 pm on March 1. If that occurs, the bill will be returned to the Senate for concurrence with amendments added in the House Health and Wellness Committee last week.
Also in Washington, the Pharmacy Quality Assurance Commission (PQAC) posted the agenda for the March 7 meeting.
Also in Washington, register now for the Apple Health quarterly online seminar on March 7 aimed at providing HCA (Health Care Authority) partners with information about current Apple Health (Medicaid) programs and program updates.
Also, in Washington, responsible pharmacy managers or equivalent managers of pharmaceutical firms must conduct an annual self-inspection in March and within 30 days of naming a new responsible pharmacy manager. The self-inspections are to be completed on Pharmacy Quality Assurance Commission provided worksheets.
Finally in Washington, the Department of Health Prescription Monitoring Program is hosting a rulemaking workshop on March 19 to clarify the rules defining the concepts of "sold", "dispense", "filled" and "distributed".
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
SF 0100 (Engrossed), legislation related to prompt payment of clean pharmacy claims, passed the Senate, and was introduced in the House and referred to the Corporations, Elections & Political Subdivisions Committee.
Also in Wyoming, Gov. Mark Gordon (R) sent the Senate his list of nominees for numerous state offices, boards, and commissions. These nominees are subject to confirmation by the Senate. Among the nominees are Summer Hanson, DVM.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alabama
The Medicaid Agency created a new form titled "Notification of Request for Medical Records from Provider." This form should be used by all Medicaid providers to notify Medicaid that recipients have requested copies of their medical records. For more information, click here.
Also in Alabama, the Alabama Pharmacy Association is excited to announce the introduction of its podcast, "Off Script" hosted by Dr. Garrett Aikens. Through "Off Script", they hope to provide important and timely updates about the ever-changing world of pharmacy. Go follow us on Spotify then listen to the intro and expect the first episode later this week as Louise and Danielle recap this week's Board of Pharmacy meeting.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The broad PBM reform bill pharmacies are supporting, AK SSSB 121 was amended and referred to both the Senate Labor and Commerce and the Finance Committees for action.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
On February 21, the Senate Committee of the Whole (COW) adopted an amendment to SB 1085 (Senate Engrossed). The bill failed the third reading in the Senate on February 22. Senate President Warren Petersen (R) offered a Motion to Reconsider.
Also in Arizona, SB 1021 (Senate Engrossed), repealing the Sunrise process for expansion of scope of practice for a "health professional group", was adopted by the Senate with a vote of 24-4-2.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
The Department of Health Care Services posted the Medi-Cal Rx Weekly Wrap-up for February 9-15 (February 16).
Also in California, the Department of Health Care Services posted the following:
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Florida
The Agency for Health Care Administration (Agency), along with its fiscal agent Gainwell Technologies, has updated the NPI (National Provider Identifier) Mapping Logic that is used by the Florida Medicaid Management Information System (FL MMIS). Detailed information on the upcoming NPI Mapping Logic can be viewed on the NPI Initiative FAQ. The FAQ and additional information about the NPI Initiative can be obtained by visiting the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigating to Agency Initiatives, and selecting NPI Initiative.
The NPI to Medicaid ID Search Engine was removed from the public Web Portal and is only available to those logged into their secure Web Portal. The enhanced tool is available by clicking the NPI to Medicaid ID Search Engine link under the Quick Links box within the secure Web Portal.
The NPI to Medicaid ID Search Engine is accessible on the public Web Portal only for those applying and entering an NPI for full, limited or ROPA (Referring, Ordering, Prescribing and Attending) enrollment through the Online Enrollment Wizard.
For more information, visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigate to Agency Initiatives, and select NPI Initiative.
For information on how to perform a password reset for a secure Web Portal user account that is locked, refer to the Secure Web Portal Account Maintenance Quick Reference Guide (QRG)
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Hawaii
HB 2553, legislation expanding pharmacists immunization authority for minors, passed its first two committees.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Idaho
HB 596, related to PBM reform, was introduced and referred to the House Health and Welfare Committee. This legislation would add new definitions; outline requirements that make contracts with pharmacies transparent and fair; require PBMs to provide transparent pricing on drugs and require PBMs to report to the Department of Insurance in a transparent way.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Indiana
As the session nears the end, there are several key dates to keep in mind. All Senate bills must pass the House committees by February 27, and all House bills must pass the Senate committees by February 29.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
The Board of Pharmacy published ARC 7632C as a Notice of Intended Action to amend Chapter 10, “Controlled Substances”. The proposed amendments would temporarily add nine substances to Schedule I and one substance to Schedule IV of the Iowa Controlled Substances Act in response to similar scheduling action taken by the DEA. Comments may be submitted until 4:30 pm on March 12.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Maine
On February 22, MaineCare announced it is experiencing intermittent network issues processing claims due to Change Healthcare network interruption. As a result, if a pharmacy experiences issues with claims, MaineCare advises to follow routine offline claims processing procedures.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Massachusetts
The Board of Pharmacy updated its standing order regarding Naloxone. Pharmacists and other pharmacy licensees may administer naloxone to someone appearing to be experiencing an opioid-related overdose and will not be subject to criminal or civil liability or any professional disciplinary action in accordance with state law.
Also in Massachusetts, the Department of Public Health (DPH) proposed changes to 105 CMR 222 which regulates the Massachusetts Immunization Information System (MIIS). The changes will:
- Expand the application of the MIIS regulations to also cover authorized recipients of the information transmitted through the system in addition to health care providers. DPH is authorized to designate other appropriate users of the MIIS.
- Shorten the time timeframe for healthcare providers to report all new immunizations through the system from 7 days to within 72 hours (3 days) of immunization administration.
- Add the following new information about the recipient that must be transmitted: the recipient's sex, gender, race, ethnicity and preferred language.
- Authorize an immunization recipient's legally authorized representative to object to the sharing of a patient's immunization information.
- Add a definition of "Authorized Recipient" to include an individual or agency that the DPH may release immunization information to for specified purposes without further consent from immunization recipients or their legal authorized representatives. An authorized recipient may not access the MIIS until they register as an authorized user.
- Authorize the Department to enter into collaborative agreements with other states for the purposes of exchanging immunization information.
Comment deadline is March 15.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Michigan
Legislation introduced last week as HB 5435 and HB 5436 would allow pharmacists to prescribe and dispense self-administered hormonal birth control to patients. The companion bill would require insurers to reimburse pharmacies for the prescription and consultation or other ancillary services including testing. It also requires that the insurer allow the pharmacy to bill the items and services under a service code at adjudication of the prescription claim.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Minnesota
The Senate Health Committee held a hearing on SF 1176 this week. The bill would update the state’s Pharmacy Practice Act to match the PREP Act’s immunization authority for pharmacists and technicians and clarify pharmacists’ ability to order CLIA-waived tests. Although the medical community testified in opposition, the committee appeared supportive of the bill and held it over for potential inclusion in the health omnibus bill package. A recording of the hearing is available online.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
The following bills are scheduled for hearing in the Banking, Commerce and Insurance Committee on February 27:
- LB 990: legislation banning PBMs from restricting an enrollee's ability to choose how a retail community pharmacy may dispense or deliver prescription drugs and clarifies that "reasonable terms" between PBMs and specialty pharmacies cannot exceed reporting requirements and performance requirements that are required for a nationally recognized independent accrediting organization among its various provisions.
- LB 1232: legislation banning PBMs from reimbursing pharmacists or pharmacies for a drug at a lower rate than the cost required to dispense the drug.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Mexico
On behalf of our members operating pharmacies throughout the state, NACDS sent Gov. Michelle Lujan Grisham (D) a letter regarding our concerns with HB 165 that was sent to her to be signed into law.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
On February 21, NYRx, the New York State Medicaid Pharmacy Benefit Program, held its monthly pharmacy sector meeting. On the agenda were the following:
- AIDS Institute – HCV (hepatitis C virus) drugs & test to treat model.
- DOH (Department of Health) asked the following of pharmacies:
- Does your pharmacy stock hepatitis C medications? How long does it take to get in stock?
- How can we get medications in the client's hands more quickly?
- How can providers build collaborations with their local pharmacies to ensure timely access to hepatitis C medications?
- How have you worked with hepatitis C providers in your community?
- Feedback can be shared with Colleen Flanigan (colleen.flanigan@health.ny.gov)
- DOH (Department of Health) asked the following of pharmacies:
- OMIG (Office of the Medicaid Inspector General) Pharmacy Audit Protocols.
- OMIG utilizes a stakeholder process for updated regulations that includes feedback from DOH and professional associations. OMIG reviews and considers all comments that are submitted before issuing a revised protocol set.
- Bill Schwarz with OMIG added that updated protocols are in development. Feedback may be shared at information@omig.ny.gov.
- Bureau of Medical Review – Incontinence Supplies.
- Incontinence products claims have doubled since 2019 and require a valid diagnosis code that directly relates to incontinence for reimbursement.
- Incontinence products info can be found in the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) Procedure Manual.
- Starting in April, the DME (Durable Medical Equipment) Procedure Manual will be updated with a separate pharmacy manual. DMPOS Procedure Manual will contain everything that Managed Care Plans are still responsible for.
- Questions: OHIPMedPA@health.ny.gov (1-800-342-3005)
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The Board of Pharmacy issued updated the Pharmacy Technician Continuing Education guidance this week.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
NACDS is closely monitoring several bills of interest to pharmacies, including SB 1541 that includes test and test for minor ailments and prescribing hormonal contraceptives, SB 1390 that would enhance the Attorney General’s enforcement powers over PBMs and SB 1670, legislation related to PBM audits and MAC pricing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
HB 4149 (A-Engrossed), legislation related to PBM Reforms, was amended and passed the House Behavioral Health & Health Care this week. Given the amendments, Chair Rob Nosse (R) stated he will be convening a workgroup after this year's regular session and outlined issues to be addressed to advance additional PBM reforms in the state.
Also in Oregon, SB 1506 (A-Engrossed) passed the Senate and was assigned to the House Behavioral Health & Health Care Committee. It is scheduled for a Work Session on February 28. This bill would allow a pharmacist to test and prescribe, dispense and administer treatment for SAVS-CoV-2 consistent with protocols adopted by the State Board of Pharmacy by rule. It would also permit a pharmacist to delegate to a pharmacy technician or an intern under the pharmacist's supervision the administrative and technical tasks of performing a SARS-CoV-2 CLIA-waived test. Finally, the bill would require payment for these services effective October 1, 2024, with a sunset date of June 30, 2026.
Also in Oregon, HB 4113 (A-Engrossed), legislation requiring all amounts paid by an enrollee or paid by another person on behalf of the enrollee toward the cost of a covered prescription drug be included when calculating the enrollee's contribution to an out-of-pocket maximum, deductible, copayment, coinsurance or other cost-sharing requirements, passed the House Behavioral Health & Health Care Committee.
Also in Oregon, HB 4010 (A-Engrossed), legislation that includes language specifying that the flavoring of a prescription drug is not compounding, passed the House Behavioral Health & Health Care Committee.
Finally in Oregon, the Oregon Health Authority's Immunization Policy Advisory Team will meet on March 7 via Zoom. The final agenda will be available at the meeting or via email request three days before the meeting date by contacting imm.info@odhsoha.oregon.gov. Participation via Zoom requires advance registration using this link. Those who register will receive a confirmation email with additional information. Note: this information is necessary to join the meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Pennsylvania
HB 2037, a bill to match the PREP Act’s immunization authority for pharmacists and technicians, has been introduced. It is cosponsored by a diverse group of bipartisan legislators that represent both rural and urban medically underserved areas of the state. Rep. Donna Bullock (D, Philadelphia), Majority Chair of the Children and Youth Committee, is the prime sponsor. Upon introduction, the bill was referred to her committee.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Dakota
HB 1147, legislation addressing discriminatory acts against entities participating in a 340B drug pricing program, unanimously passed the Senate Health and Human Services Committee and was deemed “certified uncontested” and placed on consent.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Tennessee
The Beacon Center of Tennessee’s newest report, “A Dose of Free Market Medicine,” compares Tennessee’s laws and regulations around pharmacists to recent reforms in other states, including Florida, Iowa, Kansas and Idaho. By enacting similar reforms, Tennessee policymakers can expand access to health care.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.