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.