New York
NYRx, the New York Medicaid Prescription Drug Program, made the following changes to the preferred drug list. Effective February 7, the following changes will be made to the Dispense Brand Name Drug When Less Expensive Than the Generic Program:
- Alphagan P® 0.1%, Forteo® and Votrient® will be ADDED to the program.
- Flovent® HFA and Pennsaid® pump will be REMOVED from the program. Note: Pennsaid® pump has been discontinued by the manufacturer.
- Diclofenac 2% topical solution will remain in non-preferred status on the NYRx Preferred Drug List. Prescribers should transition their patients to an alternative preferred product or obtain a prior authorization for the diclofenac 2% solution.
In conformance with State Education Law, a pharmacist shall dispense a less expensive, therapeutically equivalent drug containing the same active ingredients, dosage form and strength as the drug prescribed/ordered. This includes substituting the brand name drug when NYRx has determined it to be the less expensive alternative for the patient. Brand name drugs included in this program:
- Do not require "Dispense as Written" (DAW) or "Brand Medically Necessary" on the prescription.
- Have a generic copayment.
- Are paid at the Brand Name Drug reimbursement rate or usual and customary price, whichever is lower (SMAC/FUL are not applied).
- Do not require a new prescription if the drug is removed from this program.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
The Board of Pharmacy will be holding a Pharmacy Compounding Summit on March 6-8 at the Friday Conference Center in Chapel Hill. The agenda and details are available online.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Ohio
The Board of Pharmacy published a bulletin regarding Registered Technician license renewals. The renewal period opened on January 31.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Pennsylvania
The Board of Pharmacy has posted the agenda for the February 6 meeting.
Also in Pennsylvania, a PACE Provider bulletin announcing benefit and corresponding billing code changes to the Pharmacy Naloxone Copay Assistance Program was published. The bulletin announces a new limit of $50 per prescription and a new policy that requires coordination of benefits for insured patients.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
South Carolina
DisposeRx announced a grant opportunity and is looking to identify pharmacies in the state to provide education on safe medication disposal and dispense DisposeRx packets with controlled substance prescriptions, with an emphasis on opioids. In turn, the pharmacies will receive reimbursement for educating the patients and dispensing the packets.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Tennessee
On January 17, the Pharmacy Podcast Network announced the winners of the 2023 50 Most Influential Leaders in Pharmacy to celebrate “professionals whose thoughts, actions, accomplishments and leadership have helped solve clinical, customer service and financial problems.” Congratulations to TPA Immediate Past President Jay Phipps for earning the number two spot on the list!
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The quarterly public meeting of the Board of Pharmacy will be held on February 6, at the Barbara Jordan State Office Building, Room 2.013. The agenda and meeting materials are posted. Live live-stream information is available on the board's website. Anyone wishing to address the Board regarding an agenda item during the public meeting must submit a Public Comment Request form by 5:00 pm on February 2. Oral comments will be limited to the agenda items.
Also in Texas, Jill Dutton (R) won the January 30 special runoff election, by 107 votes out of more than 13,500 cast, to replace expelled Rep. Bryan Slaton (R) for House District 2. The victory is short-lived as she will face off against the same GOP candidate Brent Money in the March 5 Republican primary election.
Also in Texas, the Health and Human Services Commission (HHSC) drafted a policy to apply a uniform 90-day supply of maintenance medications in Medicaid and the Children's Health Insurance Program (CHIP). The HHSC received pushback from stakeholders expressing difficulty obtaining a 90-day supply of medication. You can submit comments by February 15 to the HHSC Vendor Drug Program (VDP) using the Draft Policy Comment Submission form.
Also in Texas, pharmacists and pharmacy technicians are required to notify the Board of a change of employment within ten days. This information can be found in Board rule §291.3 for pharmacists and Board rule §297.9 for pharmacy technicians.
Finally in Texas, HHSC's VDP (Vendor Drug Program) posted a pharmacy education and opportunities page on its website so that pharmacies know what pharmacy items Medicaid pays for, which products require prior authorization and who to contact with questions about claim processing.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Department of Health briefed pharmacy stakeholders, sharing recent data by age group on COVID vaccinations administered.
Also in Washington, the first of two Pharmacy Legislative Days at the Capitol that NACDS sponsored was held last week and was a huge success. Pharmacists and students were briefed on the priority issues before meeting with legislators.
Also in Washington, changes to the long-acting insulin class on the Preferred Drug List (PDL) go into effect on April 1.
Also in Washington, HB 2116, sponsored by pharmacist legislator Rep. My-Linh Thai (D), was heard in the House Committee on Health Care and Wellness last week and is now dead because it failed to be voted out of the policy committee before the January 31 deadline. This bill would have expanded prescriptive authority for pharmacists.
Also in Washington, the state's Health and Human Services Enterprise Coalition, a group of Washington state health and social service agencies, published an annual update to its Washington State Action Plan for Removing Barriers to Health and Human Services.
Also in Washington, Apple Health (Medicaid) updated several client booklets.
Finally in Washington, effective February 1, the Health Care Authority, Apple Health Fee-For-Service (FFS) is increasing the morphine milligram equivalent (MME) conversion factors used to determine total daily MME under the Apple Health Opioid Policy to the following:
- Hydromorphone MME conversion factor of 5 (increased from 4)
- Tramadol MME conversion factor of 0.2 (increased from 0.1)
The Apple Health MME calculator conversion factors are based on the Washington State Agency Medical Directors' (AMDG) and CDC guidelines for prescribing opioids for pain.
Opioids are limited to 120 MMEs per day. Pharmacy claims for opioids will reject if a single prescription or a combination of prescriptions exceed the MME limit. If a pharmacy claim rejects for exceeding the MME limit, request a prior authorization.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
Gov. Mark Gordon (R) announced the launch of an initiative to address the state’s ongoing mental health crisis. The Governor’s “Mental Health Roadmap” takes steps to advance systemic behavioral health reform. As part of the initiative, the five pillars identified as critical to improving outcomes for those who are battling mental health issues are access to care, affordability of care, quality of care, innovation and suicide prevention and anti-stigma efforts.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Alabama
The Alabama Pharmacy Association is currently accepting nominations for the chain designated seat on the Board of Pharmacy. Please submit nominations to Louise Jones by email at LJones@aparx.org or by fax to 334-271-5423. All nominations must include the name, place of employment, and contact information for both the nominee and nominator. All nominations must be received no later than March 31.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Alaska
The Board of Pharmacy statutes and revised regulations that took effect on January 19 are now posted on the Board’s website.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Arizona
The Board of Pharmacy posted its January 2024 Newsletter. See the “Compliance Corner” for important, timely updates.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
California
SB 339, legislation expanding pharmacist authority to furnish preexposure prophylaxis (PrEP) and providing payment for PrEP and postexposure prophylaxis (PEP) services, passed both chambers and will be sent to Gov. Gavin Newsom (D).
Also in California, the California Pharmacists Association is sponsoring SB 966, related to PBM reform, and sponsored by Sen. Scott Wiener (D). Among the various provisions, the bill would require PBMs to obtain a license from the State Board of Pharmacy and file annual reports with the Board. The Board, in turn, will provide annual reports to the Legislature based on information submitted by PBM licensees. Also, the bill prohibits spread pricing in future contracts and includes provisions related to calculating a patient's cost sharing amount.
Finally in California, the Department of Health Care Services posted the following weekly notice on the Medi-Cal Rx Web Portal: Medi-Cal Rx Weekly Wrap-up for January 12-18.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Idaho
The Division of Career and Technical Education posted the Idaho Pharmacy Technician Critically Survey seeking input from industry representatives about what is most important for an entry-level employee to know or be able to do. The information will be used to develop program standards for high school pharmacy technician programs in the state.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Illinois
The State Veterinary Medical Association asked NACDS to remind members that veterinarians have an exemption from the state’s e-prescribing law for the next two years. Please see HB 1358/Public Act 103-0563 (Section 311.6 (b-5, 10).
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
SB 192, broad healthcare legislation that includes a provision allowing pharmacy personnel to provide any immunization recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) to patients 11 years of age and older under a physician protocol, was referred to the Committee on Health and Provider Services.
Also in Indiana, NACDS sent a support letter for HB 1327, legislation that will provide transparency and audit authority needed to make PBMs accountable to the organizations that hire them. NACDS asked the Committee to reject any amendments that would allow PBMs and Third-Party Administrators to charge a "carve out fee" for not using an affiliate pharmacy owned by or invested in by a PBM or Third Party Administer.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Iowa
On January 24, the Insurance Commissioner, Doug Ommen, presented to the Senate Commerce Committee various issues including the Insurance Divisions’ work to regulate PBMs. To date, the Division has received 72,000 complaints and nearly $400,000 has been paid to pharmacies. The Division is currently pursuing additional authorities and policies via HSB 536/SSB 3079.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Kentucky
MedImpact will host the First Quarter 2024 pharmacy provider online seminar on January 31 from 11:00 am- 12:00 noon. The meeting topic is "provider updates and provider Q & As." You can use one of the following options to join the online seminar:
- Webinar URL
- Entering Meeting ID In Microsoft Teams Meeting ID: 218 939 299 642
Attendee Passcode: omNFva
- Call In (audio only) 1-858-252-2734; passcode138312994# v
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
Gov. Jeff Landry (R) starts his first term with a Republican supermajority in both houses. The Governor immediately convened an 8-day special session on January 15 to address three issues – congressional redistricting, reconfiguring the Supreme Court and changing the elections system.
Also in Louisiana, the Department of Health announced that effective February 1, the clotting factor reimbursement methodology will change to an average acquisition cost per unit and a dispensing fee per unit dispensed and will be limited to pharmacy claims only.
Finally in Louisiana, the Board of Pharmacy’s Regulatory Project 2023-02 ~ Temporary Closure of Pharmacy Final Rule went into effect on January 20.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maryland
The House Health and Government Operations Committee (HGO) held an informational briefing on January 25 regarding the Department of Health's (MDH) study of establishing NADAC (National Average Drug Acquisition Cost) + Fee-for-Service dispensing fee in the Medicaid Managed Care Program. 3 Axis Advisors presented to the Committee, pointing out the elements that MDH's study did not consider that would impact patient access, costs, and pharmacy viability.
Also in Maryland, on February 1, the House Health and Government Operations Committee will hear testimony on HB 76, a priority bill for pharmacy that would allow the administration of routine childhood vaccines recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) to children aged 5 years and older. Its companion bill, SB 18, is scheduled for its first hearing in the Senate Finance Committee on February 13. If any members would like to testify on the pharmacy panel at either hearing, please contact NACDS' Jill McCormack
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Massachusetts
Gov. Maura Healey (D) released her Fiscal Year 2025 budget. Included in the proposal are the following policy changes impactful to retail pharmacies:
- Authorizing pharmacies to administer injections for those persons with prescriptions for testosterone for gender affirming care and for treatment of sexually transmitted infections. This language builds on the previous expansion of pharmacist practice that authorized pharmacists to administer medications for the treatment of behavioral health conditions and substance use disorders.
- Enabling pharmacies to fill prescriptions for expedited partner therapy beyond the current authorization for Chlamydia to include other sexually transmitted infections based on national standards including the Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines.
- Increasing the maximum fill for certain classes of medication to increase access, including testosterone for gender-affirming care, stimulants for ADD (attention deficit disorder)/ADHD (attention deficit hyperactivity disorder) and medications for opioid use disorder which do not have a potential for abuse.
- Authorizing a standing order for prenatal vitamins and oral contraceptives so that federal financial participation is available for these products when pharmacies dispense them to MassHealth members and persons whose claims are paid by the Health Safety Net.
- Eliminating co-payments for persons enrolled in the Children's Medical Security Plan.
- Authorizing MassHealth to negotiate drug rebate agreements for drugs not subject to the Medicaid Drug Rebate Program such as certain non-drug products and durable medical equipment (DME).
The Governor's proposal will be considered and redrafted by the House Committee on Ways and Means over the next two months.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Missouri
The Missouri Pharmacy Association (MPA) is asking pharmacies to distribute this one-pager to educate and help facilitate action on PBM reform legislation.
Also in Missouri, the Centers for Medicare & Medicaid Services (CMS) approved the MO HealthNet Division's (MHD) application for substance use disorders (SUD) 1115 Demonstration Waiver, effective January 1, 2024.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The short 30-day legislative session focuses primarily on the budget tax and spending bills, reconciling Gov. Michelle Lujan Grisham's (D) proposed $10.5 billion budget and lawmakers proposed $10.1 billion spending plan.
Also in New Mexico, HB 33, prescription drug transparency legislation, requires reporting to the Superintendent of Insurance (SOI) and the Legislature. Failure to comply could result in the Superintendent assessing a penalty. The bill was heard in the House Health and Human Services Committee on January 22.
Finally in New Mexico, HB 35 is legislation seeking to appropriate $1.1 million to the University of New Mexico Health Sciences Center's Office for Diversity, Equity, and Inclusion communities to develop a careers program aimed at addressing shortages in the healthcare industry in New Mexico.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
NYRx, the Medicaid Pharmacy Benefit Program, updated the preferred drug list, impacting Albuterol HFA formulations. The following are preferred in the NYRx Preferred Drug Program:
- albuterol HFA – generic ProAir® HFA (8.5 grams)
- albuterol HFA – generic Proventil® HFA (6.7 grams)
- Proventil® HFA
- Ventolin® HFA BLTG (Ventolin® HFA is subject to the Brand-Less-Than-Generic Program. The generic formulation of Ventolin® HFA, albuterol HFA (18 grams), is non-preferred and will require prior authorization.)
Effective February 7, NYRx will make the following changes to the Brand Name Drug When Less Expensive Than the Generic Program:
- Alphagan P® 0.1%, Forteo® and Votrient® will be ADDED to the program.
- Flovent® HFA and Pennsaid® pump will be REMOVED from the program.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
North Carolina
Medicaid has been informed that Wellcare and Carolina Complete have experienced an issue with their new PBM (Express Scripts), being set up to pay at 30 days instead of 14 days, resulting in pharmacies not being paid timely.
Payments for the first week in January are going out in the coming week. Payments for the second and third weeks will be on a 30-day cycle and will come out in mid-February, payments for the fourth week in January will also come out by mid-February. Pharmacies should be "caught up" in mid-February.
Penalties and interest will be paid in accordance with Section V. H.1.d of the NC PHP Contract. For more information, please see the Medicaid bulletin Prepaid Health Plan Interest and Penalties for Provider Claims.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.