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California

The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.  

Also in California, the Department of Health Care Services posted the following:  

Also in California, the Board of Pharmacy proposed modifications to the following. To view all documents associated with these proposed regulatory actions and other pending regulations, visit the board’s “Pending Regulations” webpage.  

  • Designation of Pharmacist-in-Charge 
  • Temporary License for Military Spouses 
  • Modified Text 
  • 15-Day Comment Period: December 13, 2023-December 28, 2023 
  • Notice to Consumers 

Also in California, Gov. Gavin Newsom (D) appointed Sarah Brooks, as Chief Deputy Director of Health Care Programs at the Department of Health Care Services. Given the capacity to manage program growth and increased complexity of the programs, moving forward, the Chief Deputy Director for Health Care Programs and State Medicaid Director will be two separate roles. The Chief Deputy Director for Health Care Programs will focus on internal program implementation and operations in California’s health care programs, whereas the State Medicaid Director will focus on Medi-Cal policy development and relationships with its external partners, including the federal Centers for Medicare & Medicaid Services (CMS). Recruitment efforts are ongoing for a State Medicaid Director. 

Finally in California, Gov. Gavin Newsom (D) announced the launch of a new tool to continue the state’s efforts to fight the ongoing opioid crisis – a comprehensive website with resources for Californians: Opioids.CA.GOV. This website serves as a reliable source of information on prevention, data, treatment and support. Also, Californians can access information related to the state’s use of opioid settlement funds and efforts to hold drug-traffickers accountable.  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

December 15, 2023|California|

Iowa

The Department of Health and Human Services, Iowa Medicaid posted the following:  

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

December 15, 2023|Iowa|

Louisiana

The Department of Health issued an informational bulletin on tobacco cessation counseling. 

Also in Louisiana, the Department of Health (LDH) updated the available options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCO) and the state's fee-for-service (FFS) 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. 

Finally in Louisiana, the Board of Pharmacy is soliciting comments and holding a Public Hearing on December 28 on three proposed rule changes: 

  1. Regulatory Project 2023-09 ~ Product Integrity – (temperature control for mail order) 
  2. Regulatory Project 2023-10 ~ Prescription Monitoring Program (PMP)  
  3. Regulatory Project 2023-11 ~ Pharmacists Application 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Louisiana|

Maine

The Board of Pharmacy held its monthly meeting on December 7. The agenda covered the following policies and updates: 

  • Access to HIV Prevention Medications, including PEP and PrEP Protocols 
  • Access to Birth Control by Making Certain Contraception Accessible from a Pharmacist 
  • Authorize Vaccine Administration by Pharmacy Technicians and Reduce Vaccine Administration Training Requirements for Pharmacists 
  • Licensure by Endorsement  
  • Board Rule Chapter Amend Limits on Medication in Vending Machines 
  • Pharmacists Dispense an Emergency Supply of Chronic Maintenance Drugs 
  • Telehealth Rulemaking Status – Update 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

December 15, 2023|Maine|

Maryland

Medicaid published an advisory regarding upcoming denials of prescription claims due to the prescribing provider not completing revalidation. The advisory also contains email and phone contacts for patients and provider issues. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

December 15, 2023|Maryland|

Massachusetts

MassHealth has issued a new draft of the Pharmacy Manual at 130 CMR 406. The new regulations make the following changes:  

  • Adds compounded drugs, and medically necessary cosmetic drugs for the treatment of alopecia or gender identity that are listed on the MassHealth Drug list, to the list of Covered Drugs and Medical Supplies at 406.412. 
  • Deletes the language in the current regulations at 406.413 that prohibits MassHealth from paying for any drug used for the treatment of obesity. The prohibition has been eliminated and MassHealth will now pay for drugs to treat obesity that are included on the MassHealth Drug List. 
  • Adds the new section 406.446 relative to Pharmacy Drug Review and Counseling that requires pharmacies that are servicing MassHealth patients to offer prospective drug review and counseling that are consistent with the current MA law that requires pharmacists to make an offer to counsel. Only a patient's refusal of counseling must be documented. 

These changes will become effective on January 1, 2024. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

December 15, 2023|Massachusetts|

Michigan

Gov. Gretchen Whitmer (D) signed HB 4276. The bill requires PBMs to reimburse pharmacies with no more than seven retail outlets at NADAC plus a professional dispensing fee comparable to the state Medicaid Dispensing Fee. It also prohibits the Department of Health and Human Services (department) from entering into a contract with a Medicaid managed care organization if its pharmacy benefit manager (PBM) does not do the following: reimburse for a legally valid claim at a rate not less than the rate in effect at the time the original claim adjudication was submitted at the point of sale; agree to move to a transparent pass-through pricing model, in which the PBM discloses the administrative fee as a percentage of the professional dispensing costs to the department; agree to not create new pharmacy administration fees and to not increase current fees more than the rate of inflation; and, agree to not terminate an existing contract with a pharmacy with no more than seven retail outlets for the sole reason of the additional professional dispensing fee authorized.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

December 15, 2023|Michigan|

Nebraska

The Department of Health and Human Services issued the following provider bulletins: 

Also in Nebraska, the Department of Health and Human Services posted the Excel file of the fee schedule for Injectables October 1, 2023 (Revised). 

Also in Nebraska, the Department of Health and Human Services received approval from CMS for State Plan Amendment 23-0015: Adult Vaccines related to coverage of vaccines and vaccine administration in accordance with current Advisory Committee on Immunization Practices (ACIP) recommendations. 

Finally in Nebraska, the Department of Health and Human Services posted the meeting recording from the December 6 COVID-19 Provider Call. The next meeting will be held on January 3, 2024, at noon (Central). To participate, use either the meeting link or phone number and access code below. 

Join from the meeting link:
https://sonvideo.webex.com/sonvideo/j.php?MTID=mc307e2dda218d1060adfed7f454cfc16
Join by phone:
408-418-9388 (access code: 2480 661 3098 ) 

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

December 15, 2023|Nebraska|

New York

NYRx, the State Department of Health Medicaid Pharmacy Benefit Program, released updates to the NYRx Prior Authorization Programs and updated preferred drug list, changes were effective December 14. 

The State Department of Health also released a reminder regarding pharmacy providers and members out-of-pocket costs. This communication was sent to all pharmacies to remind them of their responsibility for continued enrollment, to adhere to the policies and procedures of the Medicaid Program. Specifically, it is inappropriate to allow an eligible member to pay out-of-pocket for services that are covered by NY Medicaid (NYRx) beyond copay. Please be advised that out-of-pocket expenses are only reimbursable by Medicaid for Medicaid covered services when one of these three situations applies:  

  • Reimbursement can be made for both participating and non-participating Medicaid Providers during the three-month retro period up until they submit the application. 
  • Reimbursement can be made for only Medicaid participating Providers from the date the application is submitted up until they receive the Common Benefit Identification Card (CBIC). 
  • Reimbursement can be made for both participating and non-participating Medicaid Providers due to agency error or delay. 

If there is an eligibility issue that is corrected in a timely manner, pharmacists should resubmit the claim when the issue is resolved and reimburse the member directly if the member paid out of pocket. There is support available to pharmacists to assist with claim issues. Questions regarding this communication may be directed to NYRx@health.ny.gov. 

On December 12, A6779, a bill NACDS and the Community Pharmacy Association of New York (CPANY) had been supporting to expand the 2022 law allowing pharmacists to administer long-acting injectables, was sent to the Governor's desk by the legislature. Gov. Kathy Hochul (D) has until December 22 to act on the legislation. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

December 15, 2023|New York|

Ohio

The Board of Pharmacy published a series of proposed rule changes and rescissions they intend to work on this winter. Comments are due to the board on January 17, 2024.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

December 15, 2023|Ohio|

Oklahoma

The Tenth Circuit Court of Appeals denied the State of Oklahoma’s petition for rehearing in PCMA v. Mulready. The state now has 90 days to petition the Supreme Court for further review. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Oklahoma|

Texas

The Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) now covers the 2023-2024 Pfizer-BioNTech, Moderna and Novavax commercial COVID-19 vaccines as a pharmacy benefit for both Medicaid managed care and fee-for-service, as well as the Children's Health Insurance Program (CHIP). 

Also in Texas, Medicaid will perform the semi-annual update of the Medicaid preferred drug list on January 25, 2024. The Health and Human Services Commission (HHSC) made the PDL changes based on recommendations made at the October 2023 Drug Utilization Review Board meeting. Drug list recommendations from the meeting are available. Drugs with preferred status drugs may include brand name medication which would not require a PDL prior authorization nor the value of "1" in the "Dispense as Written (DAW) Product Selection code" field (408-D8). Refer to the Dispense as Written section of the Formulary Coverage chapter of the Pharmacy Provider Procedure Manual for more information. 

Also in Texas, the Health and Human Services Commission (HHSC) is soliciting comments on the prospective clinical prior authorization proposals likely to be presented at the Texas Drug Utilization Review (DUR) Board meeting on January 26, 2024. The board reviews and recommends clinical criteria and the preferred or non-preferred drug status on the Medicaid formulary.  

Also in Texas, December 11 was the filing deadline for the March 5, 2024, primary election.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Texas|

Vermont

The Board of Pharmacy is scheduled to hold its regular meeting on December 20; the agenda has been posted.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

December 15, 2023|Vermont|

Washington

Gov. Jay Inslee (D) hosted a roundtable this week to discuss the fentanyl crisis and laid out his proposals for the upcoming legislative session. The governor’s budget adds over $50 million in new funding to take down opioids for the 2023–25 biennium, augmenting the investments from the state’s $82 million opioid settlements with drug manufacturers and pharmacies responsible in part for the opioid crisis and general fund investments within the 2023–25 biennial budget. The biennial budget allocated over $200 million for substance use disorder (SUD) treatment facility operations, rental subsidies for people with SUD, treatment subsidies, criminal diversion programs, peer support services, Tribal SUD grants and more.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 15, 2023|Washington|

Alabama

Please find the latest ALERT for pharmacy providers regarding coverage for adult vaccines, COVID vaccines and their administration. Also, an ALERT regarding coverage of adult vaccines for non-pharmacy providers has been released. Both versions have been released and will be sent to the respective provider lists. Medicaid shared both ALERTs so that individuals were aware there is a specific notice for pharmacy providers as the billing is unique to pharmacy. All ALERTs can be found here.

Also in Alabama, the Center for Medicaid and CHIP Services (CMCS) has approved a community-based mobile crisis state plan amendment (SPA) that allows Alabama to create mobile crisis intervention teams to provide Medicaid crisis services. Alabama will be able to provide these services by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days per year. For more information on this approval, please see the full Alabama SPA.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

December 8, 2023|Alabama|

Alaska

The Board of Pharmacy scheduled a special meeting on December 7 to review public comments received for the most recent publicly noticed regulations project, continue the discussion on unexpected closures of pharmacies.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 8, 2023|Alaska|

California

The Department of Health Care Services (DHCS) posted the following alerts, weekly notices, and monthly bulletin on the Medi-Cal Rx Web Portal. Please note the “Maximum Allowable Ingredient Cost 30-Day Pharmacy Provider Notice”; rates will be effective January 1, 2024, and will be posted to the Mercer Med-Cal Rx website no later than December 1, 2023. Also note the “Commercial COVID-19 Vaccine Coverage for Children” alert providing an updated policy whereby COVID-19 vaccines are a Medi-Cal Rx pharmacy benefit for members three years of age and older.

Also in California, the Board of Pharmacy provided this important alert and reminder to licensees about the drug xylazine.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

December 8, 2023|California|

Colorado

Gov. Jared Polis (D) convened a special session in mid-November to address property taxes.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 8, 2023|Colorado|

Indiana

The Health Coverage Programs (IHCP) issued a bulletin reminding pharmacy providers to submit claims with the appropriate DAW codes.

Also in Indiana, after four interim legislative hearings, the Health Care Cost Oversight Task Force issued a report with seven recommendations for legislation, including increasing transparency and prohibiting spread pricing by PBMs, third parties and insurers.

Finally in Indiana, the IHCP Bulletin 2023168 provides informational updates on the November Drug Utilization Review (DUR) Board.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 8, 2023|Indiana|

Louisiana

The Department of Health (LDH) issued a report detailing the results of key initiatives and policy goals for five major categories designed to make measurable improvements:

  • Improve health and well-being across the lifespan of Louisianans
  • Support vulnerable and underserved populations
  • Invest in and empower #TeamLDH
  • Improve performance, accountability, and compliance
  • Strengthen customer service, partnerships, and community relations

Also in Louisiana, LDH issued a bulletin outlining the available options to providers for pursuing claims resolutions and appeals of issues with Medicaid managed care organizations (MCO) and the state’s fee-for-service claims processor, Gainwell Technologies.

Also in Louisiana, LDH issued a revised bulletin with added information on provider enrollment.

Also in Louisiana, LDH announced an 11% decline in new human immunodeficiency virus (HIV) diagnoses over the past five years. As of June 2023, the number of individuals living with HIV in Louisiana stands at 22,920.

Finally in Louisiana, LDH issued a memorandum announcing that diabetic supplies will be added to the Medicaid Single Preferred Drug List to be reimbursed as pharmacy claims only effective December 1, 2023.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

December 8, 2023|Louisiana|

Maryland

The Maryland Prescription Drug Affordability Board (PDAB) Stakeholder Council will be held remotely at 2:00 PM on Mon. December 18, 2023, and is open to all stakeholders. The agenda and meeting materials will be available on the Stakeholder Council  page prior to the meeting. After registering, you will receive a confirmation email containing details about joining the meeting. To register for in-person comments, please refer to the Stakeholder Council page. You can find more information about upcoming and previous meetings of the Board and the Council, and presentation materials on the PDAB website.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

December 8, 2023|Maryland|
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